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FGR OFFICE USE: ---. <br /> - , APPLICATION FOR SANITATION PERMIT17 <br /> f <br /> Permit No. 7-._7_x, ` <br /> # (Complete in Triplicate) <br /> This Permit Expires f Year From Date Issued Date Issued -- <br /> ----------------------------------- ------7--------- ----- <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/LOCATION/,,2--,7oL2--,-----------�C - ,f. - 1�. .�--------------------CENSUS TRACT -------------------------- <br /> Owner's Name -------_^7,0VCJhf-PO--- ��C�.�----�T/"y--- ' /E�� '----------------PhoneQ - -- 1 <br /> Address ---- ---- �_ f�- Q- -- - / .�� �`"'--- City Aek " X------------------ ---------- - ------ <br /> Contractor's Name`"`---�,CYA9 1--------------------------------------------------------License �����- Phone �-C_�_--- <br /> Installation will serve: Residence Eb4a�rtment House�❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -- ---------------------------------------- <br /> Number ofliving units:----J----- Number of bedrooms -.1------Garbage Grinder .`"----- Lot Size ---_� <br /> Water Supply: Public System and name -------------------------------- •----------------------------------------------------------------------------Private } <br /> r <br /> Character of soil to a depth of 3 feet: Sand' Silt[] Clay ❑ Peat E] Sandy Loam -❑ Clay Loam ❑ <br /> }Hardpan ❑ Adobe 0 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 side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------------------- <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ----------------- i <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------- <br /> LEACHING <br /> --.--_-_--__--_LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total 'Length --_----_-_-..._---.-----_--- <br /> 'D' Box ------------ Type Filter Material ----------------_--Depth Filter Material --.-----------------.--_-----_-_----_--.-_.- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --------_----_---....._- <br /> SEEPAGE PIT [ ] Depth -----1------------- Diameter ---------------- Number ------------------------- -- Rock Filled Yes.C3. No ❑ <br /> � f <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- wr <br /> Distance to nearest. Well -----------------------------------------Foundation _______.__________ Pro bne��-�_!_------___.- <br /> -------- � - :i <br /> REP+AR/ADDITION{Prey. Sanitation permit# -----------------------'-------------------- Date --------_--F-V�- - ;--- <br /> Septic".Tank (Specify Requirements) ------------------------------ - ----------------_-------- ------=_------ --- --- ----- <br /> ----- ----- ------ <br /> 1 <br /> Disposal 'Field.,(Specify Requirements) '"f <br /> , ,c 1 igG •� #---------------^--y---�----------------------- - IS-4 ---- <br /> t S' fZr e' <br /> Xrs�r,� ---- ------------------------------------------ --------- <br /> I(Draw existing and required addition on reverse side) <br /> I hereby certify that I have'preparq this application and{that the work will-'%e done in accordance with Son Joaquin <br /> County Ordinances,,State Laws,'andMules and. Regulations,o€.th San,Jobg4i.n_Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: -.:.._ .._! s s i <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in,such manner i <br /> as to become subject to Workman's Compensation laws of .California." t 9 <br /> Signed ---- ---- ------------------ ---------- -- ------------ ---- Owner <br /> '' Title <br /> By -------- 77""� ---------- <br /> (If other than owner) <br /> FOORDEPART MrENT USE ONLY <br /> APPLICATION ACCEPTED BY Lam' -------------------------------------------- DATE .^ <br /> BUILDING PERMIT ISSUED ------------------------------—------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDI1�1bTIAL COMMENTS ----------------------`- --------'`"---------------------------------------- -------------------------------------------------- ----- ----------•---------------- <br /> - - -- ---- -- ------ -_-_----------------------- <br /> ----- -- ------------------------------------------t -------------------------------------------------------------------------------------------- -------- <br /> -------------------------------------------- > - -------------------`---------------------------------------- ------------------------ I <br /> Final Inspection b Date <br /> ------------ <br /> Final <br /> P y; ------------- ----------t---- _.----------'--------------- <br /> - SAN JOAQUIN. LOCAL ,HEALTH DISTRICT <br /> 2, a �.. ...... <br /> E. H. 9 1-'68 Rev. 5M <br />