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APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />FOR OFFICE USE: <br />(If other than owner) <br />Permit No. _ ........ <br />Date issued VT- 3 - 7.C/ <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 /> .CENSUS TRACT <br />Address _71..13 <br />Contractor's Name ./ <br /> City / <br /> Phone ,Raa3 <br /> License 4.. YL317 Phone Si 2 -02. <br />Residence Apartment House 91 Commercial OTrailer Court 9 <br />Motel 9 Other <br />Number of bedrooms Garbage Grinder Lot Size <br />Water Supply: Public System and name <br />Private <br />Character of soil to a depth of 3 feet*. SandK Silt 9 Clay 9 Peat 9 Sandy Loam 9 Clay Loam <br />Hardpan 9 Adobe 'E Fill Material If yes, type <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse <br />NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT H SEPTIC TANK [ <br />Size Liquid Depth <br />Capacity ........... Type <br />ter ial <br />No. Compartments . <br />Distance to nearest: Well <br />Founclat" n Prop. Line <br />LEACHING LINE [ ] No. of Lines Length each line Total Length <br />'D Box Type Filter Materi <br />De th Filter Material <br />Distance to nearest: Well <br />Founclat' n <br /> <br />Depth Diamete Nu er <br />JOB ADDRESS/LOCATION <br />Owner's Name MLIVR fi/yi <br />Installation will serve: <br />Number of living units - <br />SEEPAGE PIT [ <br />Property Line <br />Rock Filled <br />k.4 side.) <br />Yes No 9 iat C] <br />Water Table Depth <br />Distance to nearest: Wel <br />REPAIR/ADDITION (Prey. Sanitation Permit # <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) .../4/..57./Z3,7 ta?.41 (.7_ ....... <br />37e7 . 4d d. <br /> Prop. Line <br />1-43410.'" ........... <br /> Rock Size <br /> Foundation <br />Date <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 <br />County Ordinances,. State Laws, and Rules and Regulations of the San Joaquin Local Health <br />sod agents signature certifies the following: <br />"I certify that in the performance of the work for which this permit is issued, I shall not empl <br />as to become subject to Work n's Compensation laws of California." <br />accordance with San Joaquin <br />District. Home owner or ken- <br />oy any person in such rnannef_ <br /> Owner <br /> Title <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY . Adr"...- DATE 5 -- -2.-c- -).,' BUILDING PERMIT ISSUED DATE ..._,... ... . ...... . ........ . - . „....... ADDITIONAL COMMENTS <br />Final Inspection by: <br />....... ...... ..... . , .. .... <br /> <br />Date 4 ' <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />E. H. 9 1-'68 Rev. 5M <br />