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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> ------ W s.$.. Permit No. <br /> r <br /> " (Complete in Triplicate)� t <br /> -- -------- <br /> *e Date Issue -------_ - <br /> ---------- <br /> This Permit Expires 1 Year From Date Issued I <br /> i <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 Regulation: <br /> R <br /> JOB ADDRESS/LOCATION . _ !__- - ---f ---------------------- ------- <br /> ------------- <br /> ----- CENSUS TRACT --------------.---=------- <br /> '4 "�� <br /> Owner's Name ,tGC� / .� G,-f '-------------- ------------ Phone- <br /> Address ---------131 A�-f�.l-:l�f� 1 fig ' City _- rr�Ti r-,fes_ <br /> /'lam l------------------------------------ <br /> -------- <br /> -.... <br /> pp tl I <br /> -------.License #�� -.--�-7-sem Phone <br /> Contra' ctor's Name ---/'C��Q...-,������rtme <br /> - ---------- ---- -- <br /> { v� <br /> Installation will serve: Residence ;�Iprit H Ouse <br /> Commercial ❑Trailer Court ;❑ i <br /> Motel ❑Other --- 1 <br /> Number of living units:---/..... Number of bedrooms S-----Garbage Grinder Lot Size _� -r------� ------'- - <br /> Water' Supply: Public System and name ------------ --------- --------- --- <br /> --------------------------------------- ------------- Private <br /> Character of soil to,a depth of 3 feet,+ Sand'[]# Silt❑ Clay Peat E] Sandy Loam ❑ Clay Loam [I 1 <br /> Hardpan Adobe­[?y, Fill-Material <br /> If yes, type w -1 d t <br /> R 1 {�4 F <br /> {Plot plan, showing size of lot, I'ocation of system in relation to wells, buildings, etc. must be placed onf reverse side.) <br /> NEW-INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTICTANK- Size---1__,e---- -------�-__4 ....------ Liquid Depth ........... <br /> Capacity. 190-.-- Type49/9 -_6� Material No. Compartments _'_'A-........:.... <br /> Distance to nearest. Well ----_ 61------------------Foundation --,e"*ii�----------- Prop. Line --- ------------ <br /> f / ® <br /> LEA&ING LINE Nio. of Lines Length of each line----- ���----------- Total Length ______ _____________________ <br /> t 'D' Boxr__4?.3; Type Filter Material /Jf�Vt ___Depth Filter Material �� _--`---_.__f--- -------•---•- <br /> Distance to nearest: Well --- -------- Foundation -------------- Property Line -_____-._-_.-_---____-- 11 <br /> t'SEEPAGE PET [ Depth t-__a �---- Diameter -r .Z-___-_- Number --.-.�_------ --- ____ __ Rock Filled Yes , No i[] <br /> 'l�/. <br /> � ---'-.-'----Rock--Water Table Depth ti y s <br /> ' f.-FoundWion --------------------- Prop. Line ----------------- --- <br /> Distance to nearest: Well _ _____________'__- ----- <br /> REPAiR/ADDITION{Prev. Sanitation Permit# -------- --------- ----'-------------- Date A "-------------`-------------- <br /> j,')Septic Tank (Specify Requirements) ----- ------ .M-- ----------- <br /> , - <br /> s .3 g .......a.:....r,-:.—�-.�.n..._T,:�-.,,.��n--.wW.•w.aw�-......��..F�'�-�i.:�cp..,.. .�.d,.� <br /> - <br /> Dispasal Field (SpectEfy Requirements) ---- -------:--------•-•---- ------------------ ------------`- ------------------;---- -------------•-------- <br /> t it <br /> -------------- ---------------------------------------------------------------------------------- ---- <br /> --------------- ---------------------- <br /> 1: ---------------------------------------------= -------------------- <br /> ---------------------------------14' <br /> ir , } {Drawvxisting and required addition on reverse.,side) j <br /> I hereby certify that I have=prepared this applicato�n�anthat hlii-work_will 'he:done.in.accoMance with San Joaquin <br /> County:Ordinances, Statte'Laws, and Mules and Regulations of the.'Stri 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 subject to Workman's Compensation laws-of California.,) t"`K\ t <br /> Signed --------- -- =,. Own! <br /> -------------------------------- Title L- - ------------------ <br /> � --- - ................ ; <br /> } other than owner) <br /> FOR DEPARTMENT USE ONLY � <br /> APPLICATION ACCEPTED BY -Te ------/I/P- f 4------------------------------------------------------ DATE --.7-7� <br /> BUILDING PERMIT ISSUED -- --------------------- -- DATE ` �------- <br /> AbDITIONAL COMMENTS ---------- ------- -- -------- <br /> j <br /> ----------------------------------------- �zj -- - -7 � �� � i <br /> --- --------- ---------- <br /> ------------------------------ -------------------------------------- <br /> ------------------------- <br /> -----1 ---- <br /> i )------------------------ - --- -------- --------------------- ----- <br /> �-f -- <br /> Final Inspection by: --- 'y �-s� _ Dafie <br /> SAN-JOAQUIN+LOCAL 'HEALTH "DISTRICT ' <br /> E. H. 9 1-'68 Rev. 5M <br />