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(Complete in Triplicate) <br />This Permit Expires 1 Year Fiern Date Issued <br />Permit No. ..... <br />Date Issued .`74 444-4 7 <br />FOR OFFICE USE- <br />APPLICATIO NO FOR SANITATION PERMIT <br />Application is hereby mode to th'e,San Joaquin Local Health District for a permit to construct and install the work herein <br />described. This application is made in,compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />JOB ADDRESS/LOCATON 3 I 370 E. OSS/ E CENSUS TRACT 6 <br />Installation will serve: 4., Residence pi-cpartment House E Commercial 0Trailer Court 0 <br />Motel 0 Other <br />e:' <br /> <br /> <br />. , <br />Number of living uni Nu <br />\ <br />rnber of bedrooms 3 Garbage Grinder NO. Lot Size /5-19 X /60 <br />Water Supply: Pk .fri4 System and name\ <br />Character of sol:lit'ga depth of 3 feet: .and 0 <br />Hardpan <br />\I <br />Distance to nearest: Well 3-0 Foundation 16 Prop. Line <br />LEACHING LINE v( No. of Lines "2--- Length of each line \ ( Total Length <br />'0' Box/YS Type Filter Material Depth filter Material /(7 <br />--DiStah-ce-10-Trea'restr-Well - <br />SEEPAGE PIT <br />Distance'to nearest: Well /Oa I <br />ItEPA i IIVADDIIIIIIN (Prey. Salitation Permit # Date ' 1 <br />4 Septic Tank (Specify Requirements) <br />'t • Disposal Field (Specify Requirements) <br />(Draw existing and required addition on reverse side) <br />I hereby certify that 1 have prepared this application and that the work will be 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: <br />"I certify that in the pe P ' P once of t work for which permit is issued, I shall not employ any person in such manner <br />as to bec subject - * - pen •lion la lifornia." Jo <br />i -del <br />f <br />other than owner) <br />FOR DEPARTMENT USE ONLY <br />-1-1 13'0 L 't '-'"."; -/5-: APPLICATION ACCEPTED BY DATE <br />r <br />BUILaiNG - PERMIT-ISSUED ' DATE <br />ADDITIONAL COMMENTS PEr DEP- rrIS <br /> 0 <br />Final lnspe .. Date /741- /6 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-'68 Rev. 5M <br />Owner's Name _OH t\1 ME DI N A <br />Address / -7 7ey s .\] I : r CO 1:,y IA City Oil 14 S) Ai- E. <br />Contractor's Name aro, ... ............ ,5r,-PD C._ TAN.KS License # 2,57.1 23 7 Phone , ,.. , , <br /> Phone <br />Silt fi Clay 0 Peat 0 Sandy Loam [] Cloq-P Loam <br />Adobe 0 Fill Material .A49 If yes, type ............ <br /> Private Ft"--- <br />--41EW*ISTALIATION:„iv.()Ncl.mzptitiank repc....:1;ge pit permitted if pyblie sewer is available within 200 feet,) <br />PAb(AGE TREATMENT, [ sEpTiçTANK f. <br /> <br />Capacity ./.2 Type R?EriAST7Material cc'gCR77- No. Compartments <br />(Plot pllp, showing size_.o.fl at_ I ocatiOn_of System pnrelatibnto IIs EildingsT -OrTi7Filverse (441 <br /> <br />Size 9 )00 115- Liquid Depth <br />5 <br />; <br />Water Table Depth 30 RockSiee <br />[r( Depth tit 4,/ <br />e 1 • <br /> <br />Foundation "4- Property tine <br />Diameter X ge hlonther <br />fot;Insdaition' /49 Prep, Lira -4-, <br /> Rock figkill Vim fa----Wo fj <br />9. <br />Signed .4e <br />By. <br />- Owner <br /> Title