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FOR OFFICE USE: <br /> APPLICATIONN PERMIT <br /> .............�------.:.....------.._....- ....... FOR SANITATION <br /> ... ................. ._ ICotnplate In Triplicate) <br /> Permit No. ..7... �" <br /> This Permit Expires t Year from DaHlssued Date Issued .. ......./-/ 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION/LOCATi NO ,l k1_.. r'L� p5f_._../� e.....:1`� ?^`..CENSUS TRAICT .06.0........... <br /> Owner's Name X......... ..... ..; _ �11r-L�yA ' <br /> -- a--------• �`�,'�' `! <br /> a , .... ............. . ...Phone <br /> .................. <br /> Address -------- ._.._-_.... - ...._•----_-. <br /> Y <br /> city <br />' <br /> <- . , .. <br /> ...... <br /> Contractor's Name . ----- ! _l1 :.... - <br /> - ..License _._..._... Phone _9 .. _.:.. .. <br /> Installation will serve: Residence Apartment Housejf mmercial flTrailer Court 0 <br /> - Motel ❑Other--- ••-•- - `. <br /> = ..._.. <br /> Number cf diving units:.....,J.... Number of bedrooms Garbage GrinderP�ll �S /� <br /> Lot Size _.. ..__ ... <br /> Water Supply: Public System and,name ------------- '" <br /> ---_..:_ ..... ...::............... <br /> Private <br /> Character of.soil to a depth of 3 feet: Sand� 'Silt[{ Clay ,Q Peat Q . Sandy Loam 0. Clay Loam ❑ <br /> H" <br /> ardpan Q 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.) 1 <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,] i <br /> r <br /> PACKAGE TREATMENT.- j I SEPTIC TAMC J <br /> I <br /> «F <br /> Size..._. .. �`�'..._.. <br /> _-.- ' ,rLiquid <br /> ipC 'Caparity .. Y .:__-.. MaterialNa. Compartments <br /> Distance to nearest: Well _:_Ma.......................Foundation . . <br /> LEACHING LINE [ } No. of lines � ... Prop, Line _.��.................• <br /> ...----.._. Length of eachrline....__7�...:......... Total Length x� _ -- <br /> • 'D' Sox ::,�-_--.•- Type Filter Material� Y �?.. epth Filter Material _ <br /> ..---- <br /> Distance,ta nearest:•Weil ..,f f Foundation .fly . 67- <br /> . <br /> + ' <br /> •---• -•-- ___.._. Property Line ;�. <br /> .S <br /> PIT <br /> r <br /> .:[._h ... .....--• Drameter Number Rack <br /> q <br /> Distance <br /> 11 .... ...................•-... ...... r <br /> REPAI P o� ..... .._....... ; <br /> A R/ADDITION{Prey. Sanitation Permit. . . Date <br /> Septic Tank 1S eci Re uirements . <br /> p . fi' 1 • .......... ..................... ............. ----•------ ........ -------- <br /> Disposal Field (Specify- <br /> Requirements) <br /> --------------------------------------------------z..................... --•--- <br /> -------------••------------•-- --------------- ~;... <br /> ----. ------- -•---------------------•---- ......................................... <br /> • , r {Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this applicotion and that the work will be done in accordance with Shin Joaquin <br /> County Ordinances,.State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Horne owner or IIcert• <br /> sed agents signature certifies,the following: <br /> "I certify that in the performance of the work for which this permit-is issued, l shall not employ any person in such manner <br /> as to become subject to Workman's Com ensation laws of California." <br /> >; <br /> Signed _-... �l1L�n, , <br /> ` ---_- Owner <br /> �A <br /> By ,- - - --------- Title -------- --- <br /> (if other than owner)`' <br /> 4FOR DEPARTMENT 4LISE ONLY <br /> APPLICATION ACCEPTED BY...:......:....... :.•-- ...... ...-._.. DATE ..... ---..._--: 7 -------------- <br /> BUILDING PERMIT ISSUED ------•-----__-- _- - DATE <br /> ADDITIO AL COMMENTS -;.fi r -- � _ .- , _ i .. ��/. -;....- <br /> 1?044 - /� •�oirrco <br /> ;-finai.lnspection by: .. - <br /> M4 13 1-68 Rev. ----Date <br /> SAN J,OAQUIN LOCAL HEALTH DISTRICT g�711 3M <br />