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V <br /> <br />Date <br /> <br />FOR DEP NT ONL <br />APPLICATION ACCEPTED BY --"TI <br />BUILDING PERMIT ISSUED <br />DDITIONAL COMMENTS <br />DATE <br />.1-1./40 DATE <br />, \ • <br /> — <br />Final Inspection by: <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />7/72 3 k.1 <br />• <br /> <br />FOR' OFFICE USE-7 APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />Permit No. <br />Date Issued 47-7-7 <br /> <br />This Perriiit Expires 1 Year From Date Issued <br /> <br />, <br />Application is hereby made to the San Jooquin Local-Health District for a permit to construct and install the work herein ...' <br />described. This application is made in carnpliance with County Ordinance No. 549 and existing Rules and Regulations: <br />, <br />JOB ADDRESS/LOCATION .3) 2-16) E , floss' R. CENSUS TRACT <br />Phone <br />Address 15-0 y 2-O P /IV -6„,.. City opEs-ro <br />Contractor's Name 0-50 License # -26-7 '7',.? Phone 71 9'3 <br />Installation will serve: Residence 0 Apartment House 0 Commercial-0Trailer Court ,C) <br />Motel 0 Other c -1-.1 ( .,. <br /> Number of bedrooms Garbage Grinder Lot .Size, <br /> Private 0 <br />(Plot plan, showing size of lot, location of systein- in -relation to wells, buildings, etc. 'mt;st 'be placed on reverse side.)...- <br />NEW INSTALLATION: (No septic tank or seep' e"Pit-permitted if public sewer is available within 200 feet,) ( - <br />PACKAGE TREATMENT [ ] SEPTIC TANK - Size. T X 107( Liquid Depth <br />4 • rn <br />5-0 ' <br />'D' Box/C:5 Type Filter Matertal Tiltr -MPterial- '( <br />Distance to nearest: Well ...... . Foundation /0 Property Line tici <br />Rock died Yes No C) <br /> Prop. Line <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) <br /> <br />.../ <br />(Draw exiting and required addition on reverse side) <br />I hereby certify that I 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 SC1-13 Joaquin Local Health District. Home owner or licen- <br /> <br />sed agents signature certifies the following:. ...- —. .- <br />"I certify that in the performance of the work for which thil permit is'issued, I shall not employ any person in such manner <br />as to beco subiect to War:van'ç9pitioiiwsof California." <br />,... <br />By , Title <br />(If other than owner) <br />Owner's Name FRIA- EG.7- CON (%., <br />Number of living units: <br />Water Supply: Public System and name <br />Character of soil too depth_of 3 feet:. _ Sand .D Silt 0 Clay 0 Peat 0 'Sandy-1.oam-0 : Clay Loam 0 <br />Hardpan 0 Adobe 0FIFiaterioI If yes, type <br />6 <br />'CACHING LINE <br />Capacity /ZOO Type pnw9:57-.. Material -6)0HO— No. _6oriiiiailments <br />/Distance to nearest: Well c ' Foundation !V Prop. Line <br />Lif No. of Lines .2-- Length of each line -76-1 Total Length / <br />SEEPAGE PIT Depth /7-- - ; Diameter il.X_ Number ' `-'7.----- ,v f ,,,, <br />Water Table Depth Rock Size -A <br />Distanee to nearest: Well Foundation <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date