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FOR &FICE i1SE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------ ------------------ - (Complete in Triplicate) Permit No. <br /> - <br /> ------------------------------------------ <br /> -------------- <br /> Date Issued 4--!�----- <br /> --------------------- <br /> ------- This Permit Expires 1 Year From 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 ma/de in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION __2-_!�63 ------50------MaNT-MC04...- R ;�-:----- W .CENSUS:TRACT ---.-Y_t-----------_---. <br /> Owner's Name -------- L -_+ -1�_�---------�1- -------`��E 'A 9S _ Pfione ' <br /> 6 3 V-------6.0--------A ---------­. City -------111-T-q-------------------------------- <br /> Contractor's Name -W-V° --rt'►-A4-1 > --------------------------- 5�z -------.License # ---------:-------------- Phone ----------------------------- <br /> Installation <br /> --:-- ------ ; <br /> Installation will serve:':: Residence F;!�Partment House❑�Commer'ciol ❑Trailer Court ',❑ <br /> Motel ❑Other ---------------- s'..... -- 1 <br /> Ye <br /> Number of living units:__--f._.____ Num'ber'•of\,bedrooms _______Garbage Grinder f 'S Lot Size _RCREA61---- -------------- j <br /> '. _ --- ---- -Private <br /> WaterSuppl.y:_Public.System_and._name ---------------=� ----- � --- -- ------------------------•------ ❑ , <br /> k <br /> Char" cter of soil to a depth of 3 feet: a Sand' Silt❑ YCla i❑ Peat,❑ Sandy__Loam ,e Clay Loom E], <br /> Hardpan ❑ Adobe ❑ Fill Material;_--------------- If yes, type ---------------------------- <br /> (Pilot <br /> ______.._-_____- ____ (} <br /> (pilot"plan, showing-size- of-lot;-location of system .in,relat a.nr 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 _._2511,----- <br /> ' 2_ <br /> Capacity _.f_ Q,�TypeQ�R��-- Material rfUZ> T� Na. Compartments ______________________ <br /> Distance to nearest:-..Well ------------------------ oundation -----------I --- Prop. Line ___-- ---------- <br /> 2,LEACHING LINE No. of Lines___._._-" `_ __' gth of each line_, t�Q� -_____._._____ Total Length .---2l -___.____.__ <br /> [ ' ' Len �. <br /> - Depth Filter Material _ �_- <br /> D' Box _ _E�Type F,il;ter Material ,�0_�-�___ -----------•----------------•------ <br /> : l * /0- ----------- Property Line --------- <br /> - ���---------- Foundation ----- - - P tY �----•--•-- <br /> Distance to-n"earest- p"met Rock Filled Yes No .0 <br /> SEEPAGE PITT [ ) Depth ----------------- <br /> t �4 ;ler ---------------- Number. - ------ ----- ❑ <br /> Water <br /> Distance to n$faeest Well ----------------------------------------Rock Size - ---------------------••-•-- - <br /> pth ------------- <br />;r, 3 Foundation --------------..---- Prop Line <br /> REPAIR/ADDITION(Prev. Sanitation Perm.it#._--____.-.---------------------------------.. Date ---------------------------------- <br /> ----------------------------- <br /> ? <br /> i Septic Tank (Specify Requirements) ---------------- - t-------------;--- <br /> � k <br /> i Disposal FieldA'(Specify <br /> i Requirements) -------------------------------------------------------:1 <br /> -------------------------------------- ------------- <br /> -.----.---• --------------- <br /> - <br /> ------------------------------------------------------- ------------------ -----------' ------------------ <br /> ---------•--------------- ------------------------------------------------------------------------------- <br /> - - ------ -- - _ ---- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work,;will bedone in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations.of the. San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 <br /> as to become su • ct to r a ' mpensati.en laws of California." <br /> Signed - - -------------- ---------- <br /> ----------------------=` --- Owner <br /> By -------- ------------- -------------------------- ---- ----------- ----------------------- Title -------------- ------ ----- ------------------------------------------= <br /> (If other than owner) ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- � `+� ------------------------------------------- DATE 3 `-------. <br /> - - �--- _ - _ . . . <br /> _:---- . <br /> BUILDING_P'ERMIT`ISSUED" - z --E. . _� ._�- _. <br /> ADDITIONAL COMMENTS -------r-x= - ------- -- -",•_. <br /> ________________ s_-_-7.A.=,-------------- <br /> - <br /> - <br /> ---- f <br /> ------------------- <br /> ____________________________ _- _ ______ _ __-______ a- -.________-_____-__._________________—__-___________.--____________.___..___________-_--_._______ ----------------------------.-------------.---------------------- <br /> .,- __- <br /> Final.InsAee#i.ormjbY: •. <br /> _ `-------------------------------------Date ._ Z <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />{ <br /> E. H. 9 1-'68 Rev. 5M <br /> r <br />