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r FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------------- ------ ------------------- Permit No. _�9-�s'f!7 <br /> (Complete in Triplicate) <br /> _--__ This Permit Expires 1 Year From Date Issued Date Issued .-�-` a. l <br /> 101 <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 e in co_ mpliiaan with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION = " 7T CENSUS TRACT .____:: -------------- <br /> Owner's Name JTEHAK-----MOR L E-----9-0M_ r prAtat�--------- r-e----------Phone ---S ------I? <br /> Address -------22-1.3-6------ /ltj--1 ---------------------• Cit <br /> Contractor's Name __-0.0JArF,------------------------f--- ----------------------------------.License # -------`. - ----- Phone <br /> Installation will serve: Residerice'7❑"Apartment House❑ Commercial []Trailer Court '; f <br /> Motel ❑Other ------ �f <br /> Number of living ullit5:- -�` umber of bedrooms --— Grinder .— Lot Size-.-&R5A__F_____________ <br /> Water Supply: Public System and name --------- ---------------------•------------------------------ --------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'rt Silt❑ Gay ❑ Peat❑ Sandy Loam R9r`__Clay Loam ❑ <br />- - - "Hardpan ❑ ; Adobe ❑ Fill Material /V47--' 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,) w <br /> PACKAGE TREATMENT SEPTIC TANI Size cru /9 C_------------ Liquid Depth __ <br /> ,J1' <br /> - Capaci#Y --------------- T PePky_,�__ <br /> --- M t r a --- - - No. Compartm - -- - <br /> Distan epto�nearest; Well Fours adi f'iDr /1T_'-_ _ p. L a ______________________ <br /> LEACHING LINE [ ] No. of�LTr�es'� ----_------ l nX9-Q-31 )li ---6g-'"1.: � Total Length --------------- <br /> 'D' Box ----- Type Filter Material --------------------Depth Filter Material --------------------.------------........ <br /> Fit-TER f3m> Distance to nearest: Well --------------r--------foundation ------------------------ PrQpi" t*w ...................... <br /> fe, <br /> -GEEPAGE PIT [..}� Depth -- - -------------- Diam�cr.?©_XZ!k -------1---------.--------- hock IF" Yee zr,Mo tD <br /> Water Table Depth At- -----------------------Rock Siee �.-X--�'Z/--- - <br /> Distance to nearest: Well ___ G' __ r"t� (___.Foundation `- prop. U" .......... <br /> REIAiRI�001Tiri(f'rev. Sanitation Permit# ...... ----- --_` _'Date ---- <br /> Septic Tank (Specify Requirements) --- -------------=---------------------•--- ----- -------- ----------------------------------------------------- <br /> Disposal <br /> ------Disposal Field (Specify Requirements) ---._..___ 5_7-,M -------- ------------k---------_ <br /> ------- --- A- _G-( 1_JVY7-( RS----- � - <br /> e <br /> !- F <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 doae,in accordance with San Joaquin tj <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin;Local Health District. Home owner or licen- 91 <br /> sed agents signature ertifies the following: <br /> "I cerciUinperformanc f t work for which this permit is issued, I shalt not employ any person in such manner <br /> as to to o 's ompensation laws of CaliforniaSigned a- t_k - - -------------------------------------------- Owner <br /> BY ------ ---- -----------------`--T`+ >�D- Jitle - <br /> (If other than owner) <br /> FOR DEPART NT IJSE ONLY <br /> APPLICATION ACCEPTED BY --T,--F -a---------- ------------------------------------------------------------------- DATE ----X_( 7__4!59------------ <br /> BUILDING PERMIT ISSUED ------------- <br /> = <br /> - F--------M- ----- ----- -------------------- <br /> ------------ ---------------- <br /> ADDITIONALCOMMENTS -- -- ---- ------------------------------ --------------------------------- e-----------------------------------------------=--------------------------- <br /> ° <br /> ----------- -- ---- -------- ----------- ------ --------------------- --- ------------------- <br /> ------------------------------------ --------------------- - - ----- ---- -- --------------------, --------------------------------------------------------------------------------- <br /> -- --- ----- ---- <br /> --- - ----- ----- --- -- - ---------- . ----- -.S <br /> - <br /> ------ <br /> ------------ <br /> --------- <br /> ) <br /> e - -----Finallnspc • ---- - --�---- ---- - ------------------------------Date f- -- .,e-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> f <br />