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r%m %jrriLzuse <br /> ........... .-APPLICATION FOR SANITATION <br /> ................................I........................ _' !Complete In Triplicates Permit No. ... .7? <br /> ........ ...................... This Permit Expires I Year From Data Issued 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 /> vi <br /> JOB ADDRESSAOCATION ....... ZA` <br /> Owner's Name ..........,,�Ql�?$.' 17 a. t/ " i. .CENSUS TRACT .......................... <br /> Address ................._....... 4.`. .. .............................., ........... �. .....Pf►one ............. ....................:. <br /> :AedX.......city ... <br /> Contractor's Name ..................... . ...../l�E _ ....................................................... <br /> . .-. ....................................license # .. Phone <br /> Installation will serve, """"""'-••••••~••••••-• <br /> Residence Apartment House i] Commercial(:)Troller Court ❑ <br /> € Motel ❑Other <br /> Number of livingunits:. .° .-.. 'N _ <br /> .... umber of bedrooms Garbage Grinder ............ tat Size ... <br /> Water Supply: Public System and'name .......:.... ...._...__..................._..... G :-............. <br /> Character of soil to a depth ofi .. ... ..........................................Privab� <br /> et, Sand❑ Silt DCIay ❑ Peat <br /> ❑ Sandy Loam Clay Loam 0 <br /> Hardpan❑ Adobe❑ Fill Material ............ if yes type............... ... <br /> }Plot .plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) <br /> :NEW INSTALLATfON: i <br /> (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ Size.......... .... Liquid Depth <br /> . ............................... .......................... <br /> ] <br /> § Capacity I.................... Type .....__.. . ... Material. <br /> Distance to ..... No. Compartments .....................� <br /> nearest: Well Foundation <br /> LEACHING-LINE [ ] No. of lines ........................................................... ...................... Prop. Line ..... . ....... <br /> Ilength of each 'ins............................ Total'Length . <br /> 'D' Box .. ........ Typ Filter Material .......... ... ... <br /> e ....................Depth Filter Material ........................... <br /> Distance .to nearest, Well ....................... Foundation ................ <br /> SEEPAGE PIT [ } Depth ............. ........................ Property line ........................ <br /> --�--� - •• Diameter Number flock Filled Y <br /> Water Ta61e Depth .................................................Rock .'.....:.............. ss Q No r <br /> Distance to nearestt Well ....Found .... ... .. p <br /> REPAIR/ADDITION( San tI Foundation ........ Prop. line ...................... <br /> Prov. Ito on Permit 9lt <br /> r Date ..................................} <br /> Septic.Tank (Specify Requirements) ..............•--........... .............................................. ........ 0 J <br /> Disno al Field ISpeci Requirements) .G --.. _ -. . .............. - 'X �. <br /> ...................................(Draw existing a ..... .................................................... <br /> ad required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will 5e done In accordance with San Joaquin ( { <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin total Health District. Home owner or llcen: ; <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit Is Issued l shall not emplay an <br /> as to becom?;N ett to orkman*$Compensation laws of California."" p y Y Person in such manner <br /> Signed .......... <br /> ...... ... _ Owner 3 <br /> By ............. ... ... ..... ...... �..�.......................... { <br /> . - Title <br /> ......... <br /> (If other than owner) � ---......_. .............................. <br /> � a <br /> FOR DEPARTMENT USE ()NLY <br /> APPLICATION. ACCEPTED BY .... <br /> BUILDING PERMIT ISSUED <br /> r <br /> ! �. . .�........... +AtL <br /> DATE <br /> ADDITIONAL COMMENTS ... TE . fi.. t <br /> R...... <br /> :r� ..1...... ..................... <br /> .: <br /> final Inspection by: 1 <br /> . ' ... <br /> EH l 3 2h 1-68 Rov. $� Date ..,......' ........ .. -. <br /> SAN JOAQUIN LOCA! HEALTH DISTRICT 8/7}t 3H , <br />