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^ FOR OFFICE USE: <br /> " APPLICATION FOR SANITATION PERMIT <br /> - ---------------------------------- -- ------ Permit No. r3------3/�' <br /> (Complete in Triplicate} -- <br /> ------__------------------------------------------------ This Permit Expires 1 Year-Frorm Date Issued <br /> Date Issued .-�L-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 madein compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESSjLOC TION .z-.�?!- -� J <br /> ?M_�ya <br /> - -------- ------------------------CENSUS TRACT ----------------•-- <br /> p <br /> Owne'r's Name = --------------------------------------------------------------------------- •-------------------Phone _.L1_4— --- ------- <br /> Address <br /> ` <br /> Address - SO �C.d ------------------ City .:-. <br /> Iw <br /> --------------------------- <br /> ! p <br /> Contractor's Name . ----------------------•--------- License # --------- -------------- Phone —/5(Sl c� <br /> Installation will serve: Res idence.Apartment House❑ Commercial ❑Trailer Court ;❑ - <br /> MotelE]Other -------------------------------------------- <br /> Number <br /> ------------------------------- -- -Number of living units:_- bedrooms ___Number of g <br /> � p -.Garba e Grinder Lot Lot Size --------------------------- <br /> Y I '� JLC s -- -�/ ----------------------------------------Private <br /> Water Supply: Public System and name _ _- ._ I <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay LoamE] <br /> (Hardpan ❑ Adobe-❑ 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,) 1 <br /> / r y/ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size_Ja----,-X-_V---f�x--S-�--- Liquid Depth -------------------------- 0 <br /> Capacity -/2 00------ Type -------------------- Material__ o�Ylh�� Compartments ---- ...._ 1J <br /> 00 <br /> Distance to nearest: Well -___-_____-__-__------------------Foundation ---------------------- Prop. Line --------------- —j <br /> LEACHING LINE No. of Lines ---- --_-._ Length of each line__--_ ___� .----- Total Length ,..a�..7-.... / <br /> vn <br /> 'D' Box C.QM�._ Type Filter Material --------------------Depth Filter Material ------------------------------------•- -'- <br /> o, , <br /> } Distance tonearest. Well ----­'1_0 Foundation ----- -------- Property Line ---- <br /> SEEPAGE <br /> --SEEPAGE PIT 1 Depth Diameter --------------- Number _.-------------------------- Rock Filled Yes ❑ No : <br /> Water Table Depth ----` -------------------------------Rock ize --- <br /> r <br /> U Distance toineorest: Well ..'r._� ., ----------------------Foundation ----------------- Prop. Line _.--..-_•_-._....... <br /> REPAIR/ADDITION(Prev:Sanitation;Perm it s# _..�_ __1- ____`i__..__x_......... Date ----------------------------------1 <br /> Septic Tank (Specify Requitements)------ -----------------------------------4--� ------.--- " ` <br /> _ a I, <br /> Disposal Field ----------------------------- L. s, <br /> (Specify Requiremenfisl -� " = <br /> All <br /> ----- ---i-----------------r-- -." ---- ``--- ------------------------------------------------------------ - <br /> - ------------------------------ <br /> ............. ( ------------- ------ ---- ------- -----------------------------------•--_- <br /> ----------------- <br /> ,1 Draw existing <br /> and required addition on reverse'-;'ide} <br /> I hereby certify that I have prepared this application and,that the work.will"be done 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 bject to Workman's mpensation laws of California." <br /> Signed <br /> ----------- -- ---------------------- Owner <br /> BY F----- -- ---- Title _ O <br /> }------------------------------ - <br /> ( (If other than owner( 't ..- - 2 ;> Z/ <br /> i FOR ARTMENT U LY t- r <br /> APPLICATION ACCEPTED <br /> - --- ' DATE ' <br /> BUILDING PERMIT ISSUED ----- -" -"'-- -------------------------r-- <br /> ------------------m-°M. =` '------DATE --------------- -------------- <br /> ADDITIONAL COMMENTS ----------- --------- = _ {= <br /> -------- -------------- - ---_-- ------- <br /> -- ' .� - ----- --:j-----------------------------------------------------------------------------------------------------------------------------`- ------------- <br /> ---------------- -------------------- - ------------------ ------------------------------------------------------------------------- <br /> - <br /> Final Inspection by: ----- ` :" -- ------------------------------------------------------------ ----------------.-Date ----ar- -/ <br /> ) E <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'68 Rev. 5M �" <br />