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FOR OFFICE USE: APPLICATION FOR SANITATION. PERMIT <br /> ................................. ,� Permit No. _.6-_ .4 <br /> " (Complete in Triplicate) 1r� <br /> ....... -•...................................I...... Date <br /> This Permit Expires,l-YearromtDate lssved „- .. • .- --�' <br /> + Application is hereby made to the San Joaquin Local Health District for a permit to const ruct'and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 544.and existing Rules and Regulations: <br /> I JOB ADDRESS/LOCATION .._L.. �j1 •�� Gx._.l��c�. '.�..�_c?. 1' .. ......:._.CENSUS TRAGI .....__i............... <br /> � f <br /> ........Phane -----........_.. ...._.........---- <br /> .Owner's Name ..... ........... � <br /> ,Address ./fr�i� .5"... '.�_._ a.f•%� '. �:?....r._c.......... ...... City .._.................. <br /> F <br /> �.f_ ...................License #��:.& r C'__- Phone P3..S'' 2 <br /> CIrontractor's Name ..".�.e-�h�.,17�— <br /> I installation will serve: Residence❑Apartment House 0 Commercial QTrailer Court Q <br /> . Motel ❑Other 7:.392,)e <br /> .umber of living units:.....f...... Number of bedrooms ..:2 .....Garbage Grinder ............ Lot Size ............................................ <br /> r Nater Supply: Public System and name ................. ........................._i ------•--_-........... <br /> _ ----...... •--••-••. ------!...... .................Private te <br /> e . <br /> Peat Sandy C] Clay Loam <br /> Qwcharacter of soil to a depth of 3 feetb Silt Hardpan Adobe [3-'Fill Material--.-.'., " lyestype <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 /> I PACKAGE TREATMENT [ ] SEPTIC TANK T j Size/ rial.�,��!L'� :� Liquid Depth ..�.- 5............. <br /> // a <br /> Capacity �v._._ Type ��..4?.s.�r Mate : •- No. Compartments ...... . .... <br /> ' .Foundation ....la ----- Pro Line �c•,• <br /> Distance to nearest: Well __ _ ..'..•./ '••_-•--•- p• <br /> `l Length of each line._..-f ___ .------ Total .Lengt <br /> LEACHING LINE [ ] No. of Lines :"".� .••"--... g Y h 'l � <br /> 'D' Box Xn_.�.�T a Filter Material .2Y...�pth Filter Material .1�.................................... <br /> --- Yp - -. <br /> Distance to nearest. Well ..l.. :�.: 4. ---_. Foundation t"P". ��--------- Property Line <br /> Tn <br /> SEEPAGE PIT [ 7 Depth .......'----- -------- Diameter ................ Number --.......................... Rock Filled Yes 4 No ❑ <br /> FWater Table Depth •..............................:...Rock Size -------•-........=............. <br /> .Foundation .. Prop. Line " <br /> Distance to:nearest: Well . '� <br /> ` REPAIR/ADDITION(Prev. Sanitation Permit�#` <br /> _. Date ..............•---•------..._••--•) _ <br /> Septic Tank (Specify Requirements) -------.......................w......................----•..............-----------•-sCS <br /> ' Disposal Field (Specify Requirements) ------------------ <br /> f ---------------------------------- -------------------•---...------.....-------•---......---.........••----------•-•.............................. --------..._........--- •-•-- ........ <br /> +J p-----_------------_--------------- -•------...........--------- Y' <br /> (Draw existing and required addition on reverse side) <br /> f l hereby certify that I have prepared this application and that the watk will be done in accordance with San Joaquin <br /> i County 'Ordinances, State Laws, and Rules and Regulations of theSan Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the fallowing: <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'subiect to WWorkman' Co p nsat p laws of California." <br /> Signed ---- -- - :............... Owner <br /> I <br /> ........ . . ... . Title _....._...... :. <br /> By ----- �..�1 <br /> t (if other than owner <br /> O EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... -•- ........ --"--- - -..(�. .. � + .. <br /> DATE ... <br /> .. <br /> BUILDING PERMIT ISSUED . ..........DATE -------•--......�•• _._... <br /> ADDITIONAL COMMENTS _ .. .............................. ...................................... ... <br /> ----......_------................ .. ... ..�.---....I..................--••-- •--•- .._... . ..................---•-•---• •--------...._.---•--•-----.............-----................_ <br /> --•--------------------------._._......... ,. ---------­-------------... <br /> •............... <br /> . -•---- -�..- . . . <br /> _1......._••-----•--. <br /> ...................................................•----..........----------..__ .D � <br /> . ate <br /> ...................... . .. ..Final Ins ectionbSANJOAQUIN 'LOCAL,HEALTH DIST - <br /> 7/72 3 M <br />