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FOR OFFLCE,.USE,. SANITATION PERMIT <br /> FOR OFF I E S_ APPLICATION Permit No: <br /> E. <br /> C IU <br /> ----- ------------- -- <br /> ------------------ ----------------------------- (complete in Triplicate) Date issued <br /> - - - ------------- - ------------- <br /> -----------------!�-------------------------------------- This Permit Expires 1 Year From Date issued <br /> ---- -----;- <br /> described. <br /> - ----- --------------- construct and install the work herein <br /> Application is hereby made to the San Joaquin Local Health District for a permit to const <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> ----CENSUS TRACT <br /> JOB ADDRESS/LOCATION .------7601------fE-- --------Phone 3 <br /> Owner's Name ----------- ----------- <br /> --f-mr---------------------------------------------- <br /> ------------------------------ City T <br /> Address -------76-04----------E---- License # ------------------------- Phone <br /> Contractor's Name ----OVV-t4- - --------------------------------------------- <br /> installation will serve. Residence ❑ Apartment HouseM Commercial❑Traile:r-Gaam 19- <br /> ,,Motel F1 other ------------------------------------------- <br /> Number of living units:--- - Numb I er of bedrooms- ______-.__-_Garbage Grinder ------------ Lot Size -------------------------- ------------------ <br /> ------ Private [I <br /> Water Supply: Public SYst6m and name ------------------------------------------------------------------------------ <br /> Sand'M Silt j-] Clay E] peot.n Sandy Loom ❑ Clay Loom.0 <br /> Character of soil to a depth of 3 feet: <br /> Fill Material ------ <br /> Hardpan El Adobe -E] ------ if yes,type ---------------------------- <br /> ed on reverse side.) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed <br /> tank or seepage pit permitted if public sewer is available within 200 feet,) CA <br /> NEW INSTALLATION: (No septic --------- <br /> I IC TANK Size------------------------------------------------ Liquid Depth -.------ -------- <br /> I TREATMENT I I SEPT <br /> ----- No. C <br /> Capacity i--------------------- Type <br /> Distance to nearest-. Well ------- - -------------------------------------------- Material----------------- ompartments ----------- <br /> -Foundation ---------------------- Prop. Line ---------------------- <br /> - - - i <br /> ----- Total Length --------------------------- <br /> LEACHING LINE No. of Lines ------------------------ Length of each line----------------------- <br /> -----------Depth Filter Material ------------------- ------------------------ <br /> 'D' Box ------------ Type Filter Material --------- <br /> `­ zi� Prop" Line ------------------------ <br /> Distance-oto nedrcVt Well -•--- -- Foundation ---- ------------------- t No [03 <br /> --- Number ---------------------------- Rock Filled yes C] <br /> SEEPAGE PIT Depth)j-----.-, - ameter ------ <br /> Water-Tcible-Depth ------------------------------------------Rock Size -------------------------------- <br /> --Foundation --------- ---------- Prop. Line�--------------------- <br /> Distance to nearest: Well ----------------------------•--------- <_ <br /> REPAIR/ADDITICIN(Prev. Sanitation Permit# ------- ------------------------------------ Date ---------------------------------- If- <br /> Tki*wv --------------- -- ---- ------------ ---------- <br /> Septic-Tank (Specify Requirements) ------------- ------ 5 --------------- <br /> )k-f <br /> Dispo-scil Field (Specify Requirements) <br /> uTtAJF4 Y, ------- <br /> sr— r—:/— — -------------------------------- <br /> ----41 VIA------E_ P -------DVV-------L---1 PP- 4---------- <br /> (Draw and required addition on reverse side) <br /> (D.ra tluin <br /> pared this application and that the work will be done in accorclance-With Son Jou <br /> I hereby certify that,I have prepared ken- <br /> �,*.kn.N. s of the Son Joaquin Local Health District. Hothe owner or <br /> County Orclir�ances,State`b0'wSi-,"a"nd 'Rules and Regulation <br /> sed agents signature nature certifies the following: I in 'Such manner <br /> "I certify that in the performance of the work <br /> 9 11 for which this permit is issued, I shall not employ any porson <br /> as to become subject to Workman's Compensation laws of California." <br /> ---------- <br /> Owner <br /> Sigr, ✓ ----------------------------- <br /> Title - -------------- -------------------------- ----------------- --------- <br /> By -f---Il , ------------------------------------------------------------- <br /> (if other than owner) <br /> FOR -DEPARTMENT USE ONLY <br /> --------------- -- --- <br /> -BY--- ------------ ------------------------------- - - —— DATE------------------ <br /> APPLICATION ACCEPTED -------I---------- <br /> BU I LD ING-PERMIT-1 SSU E D <br /> ----=-=------------ - -mdlvb------ <br /> OITIONAL COMMENTS -W iiti------A5,yyy-1&--- jo--------e <br /> AID _S.-- -0--- ........PA_09-5 4 _7 IV IT,- <br /> iFnic-n.0t ----T_ I-- I - . --------------------- <br /> r5-0t77- -----------------------------I-------------- <br /> ---- ------- <br /> --------- ----------------------------------------------------- --------- <br /> ---.Dcite ----------------- <br /> ---- ------ <br /> Final Inspection by-- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9- - 1-'68 Rev. 5M <br />