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T <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ...... ...........I..........I'll............. Permit No. 75....... <br /> I (Complete In Triplicate) <br /> ...._.........I....._...._ <br /> Date Issued .Zd-.�...... <br /> ...................... This permit Expires I Year From Date Issued <br /> .. ............ <br /> Application 'is he?eby made to the San Joaquin Local Hicifth Districtfor a p;rmit to construct and install the work herein <br /> described. This application is made in compliance with County OrdinoniekNb. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..............I.....---- <br /> ' .. . . <br /> .......I.... <br /> ............... <br /> ._..._.......CENSUS TRACT <br /> Owner's Nome L/49AY. .. .... I A . C ... .......... ... . . .... . . ......P one <br /> ............. <br /> Address ....KIIP ..... ............. . .... City <br /> ......... ...... .........fL,p.p ....... <br /> -P j2.-_,_S6eJ11C6.Aicense # Phone <br /> Contractor's .. ..rx....7wzy <br /> Installation will serVe-S Residence nApartme -'House C] Commercial {]Trailer Court C] <br /> Motel ............ t Size ....... <br /> Number of-living units:.. ._.._..__ Number of bedrooms n�2.6......Garbage Grinder ............ Lo 1 <br /> I i ;? 1 0 <br /> WOW SUFPPIY: Public System dnd name ............IAI private <br /> .......................!...... .......................................... <br /> Character of soil to aYfeet- Sand Q--'Silt 0 Cloy 0 Peat D Sandy Loam C1 Cloy Loom 0 <br /> depth of a <br /> Hardpan F] Ado.be 0 Fill M6feriol .......1... If yes,type .................. .......... <br /> IN t plan, showing size of lot, loco%taon-.of,.sy.stem-in-relation-ta.wells, buildings, etc. W%ust be placed on'• reverse side.) <br /> NEW INSTALLATION: (No septic ton or seepage pit permitted'if-public sewe'r is ovallable within 2.00 feet,) <br /> PACKAGE TREATMENT [.1 SEPTIC TAMC,-j Size...... ......I........... ....... ....... Liquid Depth ........................... <br /> nts <br /> Capacity .... ....... ... Type S�tn............ Material---------------------- rNo. Compartments .................... <br /> `Distance F Prop. Line ....................... <br /> to nearest: Well ..... ......... ......____Foundation... oundation' ...................... <br /> LEACHING LINE <br /> ], No- of Lines <br /> ......... ............ Length of each line.._....................I;-? Total Length" .....k............... .. .. <br /> 'D Box ......... Type Filter Material ` <br /> ..... ..0eptl4 Filter Material .:----_•----•............................... <br /> —Distance-to neorestt-Well ......I.......I......... Foundation ....................... Property Line .................. <br /> .. .... Rock Filled Yes [2 No 0Z <br /> SEEPAGE PIT Depth ...................... Djamiter ................ Number ------ ---- <br /> Water Table Dep ........ ......... <br /> th ---- --_ Rock.Size ......... ...................... <br /> n ii <br /> nearest. Well ........... ....... ...................Foundation ...................... Prop. Line ....... ............. <br /> Distance to <br /> Date .1......... ............ <br /> IR/ADDITION(Prev. Sanitation Permit .................................... .......... <br /> nts) .... ......... .................... .................. <br /> Septic Tank (Specify Requirements) ........ .. ......... ....... •;••-....... ..-----•--.............M_.... <br /> DisposalLo... .........+_ <br /> .................. <br /> Field (Specify Requirements) ...... ........... <br /> P I 1�"o <br /> ..........I .. .....:��. A ......... ... ------ ...................................... ...... .................... <br /> .......................................................................... ................................._ .......I.. .._._.............------•--:__-_-............--------._.........-•------. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared j�hls application'and that thet'work will},bo done-In accordance with Son Joaquin <br /> t. eg <br /> County Ordinances, State Laws, and Rules and Rulations-of the an Joaquinkocal Health District. Home owner or licens. <br /> +1. - <br /> sed agents signature certifies the following- <br /> "I certify that in the performance of 1h6 work for which this permit islssued I i.shall not employ any person In such mannet <br /> as to become sub* to Workman's Componsation laws of California."' <br /> 0 <br /> Signed .......... ........... .......................... Owner <br /> V. <br /> By ............ .. .. .rte... ..... . tie ...... <br /> f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .......... n..........I...........................I............... ........ ............ DATE ............... <br /> BUILDINGPERMIT ISSUED ................. .................................................................. ..........w...DATE ---7--------- ............................. <br /> ADDITIONALCOMMENTS ..............................................................................•--........._._--- ------..............-------•--....::•---.....----_............. <br /> ......................................... .......................... .......4.................;.......... ......I................ <br /> ........................................................... . ........I.....,....... <br /> ----------------------­­­*­­­........ .................................................... ........................ <br /> ............ ....C.............................. .................... ... ..........I............. <br /> ...............--------•............................ ................. ......" 7 <br /> ..........Date <br /> Final Inspection by: ............... ......%.dr...... ................. ............................:..................... .................. <br /> SAN JOAQUIN LOCAL,HEALTH DISTRICT <br /> 7/72 3 X <br /> 13. 24 gm _. -1 <br />