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YOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 7L-- e74,7 <br /> (Complete In Triplicate) Permit No: .................. <br /> ... <br /> --------------------------------- This Permit Expires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> R0-7 <br /> JOB ADDRESS/LOCATION ..A.7�,�� ..__s _.:....M .P ---R0. ... <br /> '.................. .......CENSUS TRACT ........ ................ <br /> Owner's Name ......l��iS..........i.vfgt1.s.-: ...... .RI A.N.--•- ...........................(Phone ................ . ..... ...... <br /> Address }...b_.�� ..... .........:M_VIR. ... .:._..-• City .A}t-�N:............................. ........... <br /> Contractor's Name ( t- _..- <br /> kA License # /C.t_`I�- Phone <br /> Installation will serve: Reside a Apartment House 0 Commercial ❑Trailer Court <br /> Number o s : <br /> Motel-❑Other ............................................ � f I <br /> f living units;.__ ________ Number.of'bedroom _ .::..:Garbage Grinder ,--_.___ .�-Lot-Size-..._. __ _cRe�. -ar............. <br /> Water Supply: Public System and name,...................................................................................I....- ------.Private ❑ ' , <br /> Character'of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ P.eat 0 ::Sandy Loam Clay Loam ❑ I <br /> Hardpan Adobe Fill Material ._JYQ:If es, a ...._..._.____.._.._._______ f <br /> A ❑ ❑ Y type <br /> _(Plot plan; showing size of lot,�location of. system- in relation to wells, buildings, etc. must be placed on reverse .side.) <br /> i:W INSTALLATION:No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r <br /> PACKAGE TREATMENT (_]---SEPTIC <br /> TANK''t ]� �-- T�„ � 5#ze.__�.*......_..-�-•.•---.._....1.f <br /> Liquid Depth -•+ .^�-•---_---- <br /> `� - -_------- T e Material f Corn ortments �.. ............ <br /> Distance to nearest: Well ---...... `_... Foundation .. . Prop. Line ..................... <br /> LEACHING LINE ( ] No. of Lines ........................ Len th of each line-`--------- _.. otal Length ............:............ <br /> "z"` �,�Q Box -�Type=Filter,¢Mat ial .:. ,bepfh'rFilteP a) <br /> Y <br /> ;.: i .... ._ ... . <br /> - - , -- �we•►+7r '.V•w• Mclr. t � £....� . _ - i.�..... r�..�.l�.�ew�--.�.�.r.�- <br /> .. - �. .•' '!Distance to nearest: Well v � � �_'.. Foundation Pro a L#ne 1'SEEPAGE PITS [ ) Depth Diameter .. ............. Number ..._......_....... Rock Filled Yes ❑ No 0Water Table,.Qepth ... ......... ....... .RockSizeDistance to nearest: Well,::.: ..... ...Foundation . ........ Prop. Line .REPAIR/ADDITION{Prey. Sanitation Permit# .' :.'........................:....__..._.. Date --------.____- ......... <br /> ) <br /> Septic Tank (Specify Requirements) ....41/—P .yySTFE6.j------FAN.w-Ra--------•---- -----------------------------------------------=- --•- <br /> D�sposal Field'(Specify Requirements) P_4PX.fT- ..F-XL$T7NjC-------syM. .--------IiUr1 7,F-------nP L!✓.-- . <br /> / .c�2�.� ------- ------:9---------4-gip_-------- .. ma------- ...._..4jw;;s <br /> 3 t <br /> # (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that tiie work will be done In accordance with San Joaquin,- <br /> County,Ordinances, State.Laws,-and Rules_and:Regulations-of=the-San-Joaquin L'ocat�Health`Ditt�ict:dome`own o sed agents signature certifies the following: <br /> "1 certify;thot in the performance.of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to bec me su 2 ct to Workman's Compensation laws of California," <br /> nc f ` <br /> Signe ---... ................ ................................................. Owner f <br /> By .. _ ............................................................. ........... Title ...._............................................................_..... <br /> --- . <br /> ( f other.than owner) f f <br /> `� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED , .M41 wIJT(.._. I ' Z '�' <br /> .... DATE 6...-----`7-------....: ...... <br /> BUILDING PERMIT ISSUED ..'.............. .... <br /> .....................................................•-----.._....._.............._DATE .......................................... <br /> ADDITIONAL COMMENTS . - Y . . - - ...................................- - <br /> e _ _. y <br /> ....._.....................................................................' . S -�.. . �- :� •.... .` ..f�. ... .M..`- ..3�. ........_....._............_...-.....__..__........_......__.._. <br /> _....-----•-------------------------•------_....._.w_.__... ... .:............ . ..................-...------ --- - <br /> ............................... ...... .. _. .........___...._...___....-•---• �� ........... <br /> ------- .................... .... <br /> Final Inspection by. ................ ................ <br /> ----•-•-------- �•......................................Date <br /> SAN JOAQUI CAL HEALTH DISTRICT <br /> r.. H.13 24 t.,ea j?, seA 7/72 3-:d- ' <br />