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� M <br /> .. FOR OFFICE USE: <br /> :. :. .. PERMI4 V6T i <br /> ` p p Permit No: !-3_ <br /> APPLICATION FOR SANITATION <br /> -'Com lete in�Tn Iicaeel -,tp _ .� <br /> ---------- ------+------------------------- ------------- <br /> Date Issuedq----------------- <br /> ----------------a___ --------------------____------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the SaJoaquin 1:ocal Health District for a permit to construct and install the work:herein <br /> described. This application m ­�is nade in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> j. <br /> JOB.{ <br /> A D <br /> 10N <br /> -j'.. Z e�It--- � <br /> -------CENSUS <br /> aTRACT ---3------"------fl-- <br /> -- <br /> -fyf! <br /> -9tb------ ------------- - - phoneOwner's Name � = �° ' • ----------------------- <br /> -----------­-- <br /> f <br /> '------- - <br /> f - ----- ------ --------- - ------�-- rAddress - -- ----- - Cit --------------------- <br /> i- --- <br /> -LicenseContractor's Name --- - --- -------- - J_7---- Phone- <br /> Installation will serve:.,." �� Residence Apart ent House❑ Commercial : Trailer Court i❑ <br /> Motel E] Other --------------:-------- <br /> Number of living units:=w:- 1---_-- Number of bedrooms_-- -3-...Garba_ge Grinder _` Lot Siie - - Q_"p ��� <br /> --- <br /> L i 3.� ❑ i <br /> Wat Supply: Public Syp}em and name -------`0----------�---------------------------------- ---- -y----- ----�- ------------------Private�E <br /> Character of soil to a de of 3 feet: Sand' Silt CIOPeat I and ' Loam'o Loam . <br /> h <br /> Hardpan ❑ Ad`obe (] Fill Material - If yes, type ------'---.-___--_---- <br /> r r t i <br /> (Plot plan, showing size of lot, location_ of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW,INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> SEPTIC TANK.[ fr__---- Liquid DePACKAGE TREATMENT th <br /> Capacity d-Q_-----_ Type -_ Material- -[.wxe - No. Compartments ___ _ ..-_-___ J } <br /> i Distance to nearest: Well _-------5G----- --------------Found'ation ?_f-Q------------ Prop. Line .__ -_-:_.__--_� <br /> LEACHING LINE [ ] No. of Lines ------------------------- Length of each line.---------_------_i- ------ Total Length ----------------------------­ , <br /> aD' Box _ __-_-_ - - Type Filter Material --------------------Depth Filter Material <br /> Distance to nearest: Well ------------------------ Foundation—_! --------- Property Line ------_ ----- - ------ <br /> SEEPAGE PIT [ ] ' Depth -----_3__---__----- Diameter --------------- Number -------4�-------------------- Rock Filled Yes No C <br /> ' Water Table Depth --------- -- - -- - - I <br /> �3 Rock Size <br /> 1 ---------------- E -- <br /> -- Foundation =!!------------------- Prop. Line ----------- .......... 10 <br /> REPAIR/ADDITION(Prev.DSanitation Permit#We-1---------------------------------- Date --- 4 ---Septic Tank ) <br /> ------------------------------- -------------------------- --------------------------------------------------_ <br /> � 4 i <br /> Disposal Fie(ldp(Specify Requ remsents) -------------------------------------------------- <br /> --- ---------------------------------------- ------- ----------------------------------------------------- --------- <br /> ----------------;------- -----------------------------------_-------------- --------- <br /> ----------- ------- <br /> (Draw existing and required addition on reverse side) i <br /> I hereby certify that 1 have prepared this application and that the work will be "done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: f <br /> "1 cetify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to+become subject to Workman's Compensation laws of California." <br /> Signed`----�----------------------------- ------- ---------------------------------------------------- Owner-------- ----------------------------------------- N <br /> By�r�r (If other th owner) ` Title -------------t---------------------------- ---------------------------- <br /> f <br /> I i <br /> I, <br /> FOR DEPARTMENT USE ONLY i ) <br /> DATE . 9 -- --------------- <br /> -- <br /> APPLICATION ACCEPTED BY ----- ------ ----- -- - -------------------------- ------------------------------- - -0_1'23- <br /> BUILDINGPERMIT ISSUED ------------ ------------------------------------------------------------------------ ------------------DATE ---------------------------------=-------- j <br /> COMMENTS -------=--------------------------------------------------------------------------- fj----------------------------- ----------------------------------I----------------------------- ---------------------- ----------------------------------------•-••---- <br /> i I - <br /> ------ ------`------`--------------------------------------------------------'-------------------'----------------------------`------- ------------------ r <br /> --------------------------------------------- <br /> I------------------- --- -- <br /> fc.�al,lnspec#ion by: ----------- --- --------------- ------------------ ---- - ------�------------------,Date --�..--- ''-�----------�--,-------- <br /> SAN JOAQUIN,LOCAL. HEALTH DISTRICT <br /> E. H. 9 1 x'68 Rev. SM <br />