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FOR OFFICE USE: 1. 1 <br /> .. '" APPLICATION FOR SANITATION PERMIT, <br /> ....._....................�............................. ' r Y <br /> ' �,(Coinplete,ln Triplitat�)� + t Permit No 7�----_------- <br /> ,1 <br /> ......................................................f . This Permit Expires 1 Year From bate IssuedDate Issued .._...� _...... <br /> Application is hereby made to tlye ban Joaquin Local Health District for a permit to construct a d install t4—,work herein <br /> described. This application"is made in compliance with County Ordinance No. 549 and existin RuleCandiReg0btions, <br /> < <br /> 'JOB ADDRESS/LOCATION ' .......... 1 `_11.PR.C�.......CENS TRACT ' ...... <br /> Owner's Name ............... ..it`1 g.:ca' :�7f`............ ..F:.*U_.K..........................................PhonaN&J.� 16 ,6.7n4, <br /> � : <br /> ssxqj <br /> .. ............. <br /> f <br /> Address 1. .. ..........�.1 _ 'Y� City /'`a-fir Q-3`' 1'.. Ems' <br /> .�_, . l 2.1%.-...�1. . ........:.......... _ ��. e_-.� <br /> Contractor's Name --____-. t�.�.k� ._-.... k.Q.k License # .x"7!:119$'... Phone <br /> Installation will serve: �� Residence IN Apartment-House C-oramercia[(Trailer Court <br /> .- a wM � C]C►the` <br /> -_..Garbo a Grinder . _ .. .... Lot Size . <br /> 9 /� <br /> tJ�mber of living units:.._ Number of bedrooms�� ���� � ..,,. <br /> Water Supply: Public System and name - _ - Private <br /> -- i <br /> ('.Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay ❑ Peat❑ ntl, Loa ..., Clay Loam M . <br /> e- Har a X_� Adobe Flll Material_ if yes,type <br /> .`.{plot plan, showing size oflotAIocation of-system-in'.relation_to ve1s,, builcligs, etc. must =ptaced}an regie side.) <br /> 200 fe6tj EA <br /> KAGEAkLATION: {No septic tank or seepage pit permitted if .pub#jc sewer is available n <br /> with'i <br /> jw. <br /> [ TREATMENT ( ] SEPTIC TANK f-r Size..... _.0..91%L—..__. ;t-Ltquid Depth <br /> CopaLc,Lty . �?�L s Pe •F.d.�-tom} Mal r3al� ar3- 't� �,Na. :Comportrt�ent ..N.. ..tl <br /> .- c„ <br /> i Disancto nearest:=Well rt <br /> �---- <br /> � -- ��----------Founc�asionProp. Lir- . D8 <br /> te -•- -- -. <br /> LEAGHJNG LINE ) J No. of i:ines ... -.__.. LengtWof each line-..... f .... Total Length" .,........ .f <br /> 'D'I!Box ?... Typ F'ilterj"Mbterial /1.94kDepth Filter Material " ..- .................4 <br /> Distoncelito nearest: Well ...i..&O-Sr... Foundation .'z >.. ...... Property Line �_ __....... <br /> --. �CA-�Q .�.....: � � <br /> SEEPAGE PIT ( ) Depth .'� .�---.---... ©iometer -- Number .._ ........... Rock Filled Yes No <br /> it . �. <br /> Water Table Depth __-.._fJiec+� .Ate.......... ....Rock"Site .� .----- <br /> 1 �j�j IF 1"1 '-i4 <br /> REPAIR A[#DITI N(Prev. litnearest: Well ..� _. ........... ..Found4ibn ' .-- Prop. Line Z� .__.-�_..d <br /> ' / O ! Sanitation. e it# Date ...................... <br /> .. ...... ) ' <br /> SepticTank jSpecify.Requirements) -•............................................ .................................................... --- ..............................� <br />' Disposal Field (Specify Requirements) --------•----------------------------------•-------------------•---_- .................. ..........,...................... <br /> T , <br /> -- ------ ------------------------------------------------ ----._....-- ............---- .................. <br /> ----------------- -------------------- -- ---- -------..._........ ----•-- ------ ------­----------- -------•- •-----------------------------------•------ ................... <br /> :F (Draw existing and required-addition on reverse side) <br /> 1 hereby certify that I have.prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State L' ws,--and Rules and Regulations of the Son Joaquin total Health District. Hance 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 subject to Workman's Compensation laws of California." <br />'. .I <br /> Signed .. ------ --------------------------------------- ...... ....... ------------ Owner <br /> -BY " '•--------• .. .-.... . Title .... ----------- -'------ ------------------•---- ............. <br /> (If other than owner) <br /> F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED l3Y ` ' DATE. --------------- <br /> f BUILDING PERMIT ISSUED :......... `....:........•-- ..._.. . ..--- ....... _ <br /> ADDITION, L MM NTS *X;'; <br /> �.. ..................... .._...._---...•---- --- ------- ------•-•------ ---------- ..--------'--•--------- .. .....:.........----:-------- .................................... <br /> ------------------ <br /> Final Inspection b ..r-- ................................. Date .... <br /> EH 13 2h 1-68v• 5M ;I SAN JOAQUIN LOCAL HEALTH"b1STRICT 8/7b 3M <br /> u 3 <br />