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:Title <br /> Owner <br />FOR-:DEPARTMENT USE ONLY <br />side.) <br />Sandy Loam 0 Clay Loam <br />. If yes,,type' <br /> Jr' <br />s, etc. must-be placed on reverse <br />is available Within 200 feet,) <br />Liquid Depth <br />0 <br />••••--2.41, <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />Application is hereby made to the 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/LOCATAN .3i ./ Rossi E CENSUS TRACT S <br />v. <br />__...ywAyni /4 (24-RR Phone <br />-31-1 City r. <br />UIALSP, ----- - <br />Installation will serve: Residence 0 Apartment House Commercial 0Trailer7Court <br />Number of living units - <br />Silt Clay 0 Peat 0 <br /> <br />Adobe ET' Pil I Material: - <br />(Plot plan, showing size'of lot, location of <br />NEW INSTALLATION: (No 'Septic tank or se <br />PACKAGE TREATMENT [] SEPTIC TANK 1 <br />Ca pciceilt0 <br />,Distance to nearest: <br />No. of Lines <br /> <br />'II Box Type <br />Distance to nearest: <br />Depth <br />vVater Table Depth <br />Distance to nearest: <br />REPAIR/ADDITION (Prey. Sanitation Permit # <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) TiensiK <br />(Draw existing 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 San Joaquin Local Health District. Home owner or licen- <br />sed agent si ature certifies the following: <br />Signed <br />By <br />(If other than owner) <br />Owner's Name <br />Address . <br />Contractor's Name License,# z Phone <br />Motel 11] Other <br />.1 Number of bedrooms Garbage Grinder <br />LEACHING LINE <br />SEEE'AGE PIT <br />-11.J <br />s,] d <br /> D ameter Number .. Rock Filled Yes 0 No <br />stem' in relation to wells, buildi <br />page, pit permitted if public sewe <br />Size <br />ell <br /> Length of each 'line— • otal-tength <br />ilter Material Depth ilter.•Materiat. <br />Foundation el, Property Line 1 <br />Material ---- .... No. -Compartments <br />Found <br /> Rock S. - <br /> Found.- •n Prop. Line <br />Date <br />tion Prop. Line <br />Z— _60 1.4 <br />_ <br />"/ certi in the perfoiii9nce of the work for which this permit is issued, I shall not employ any person in such manner <br />as to bnje subject to man's Compensation lawsof California." <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />..... • <br /> <br />DATE . ,,e//` <br /> DATE .... <br />—.DateTit. . .2 <br />........... • <br />E. H. 9 l -'68 Rev. 5M' <br />Permit No, 73-3° <br />Date Issued <br />Water Supply: Public System and name <br />Character of soil to a depth of 3 feet: Sand <br />Hardpan <br />5 Lot Size /9-Efl <br />Private <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />Final Irspfl <br />el. _ <br />FOR OFFICrUSEi