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FOR OFFICE USE: APPLICATION FOR SANITATION,PERMIT <br /> ......................... {Codeplate In Trlplltatal --- Permit No ...... . _ s{ <br /> .. .... ............... Dat® lssued,�: Z.' <br /> .. ... . ........ ... .. . ... This permit Expires t Year From Dote 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: s <br /> J06 ADDRESS/LOCATiON . s��c�.�. .,f'D6�.��.1...��i��.. ..............:.CENSUS TRACT ............... <br /> ' ..:. _.... ......_....Phone .._.., .......... ........Owner's Name -.�c.. .............:.` <br /> Address'L' city .p......,_.. f r� .f <br />` COrltrdCtor'S Nacrae� `:. a, Q. .. [fi �5�� :.......:.......i.:......i.iC@ /�. .[..' l ilonB�J`I�M ::PA �r�� <br /> installation will serve.,: 4 Residence Ef Apartment House fl Commercial(]Tralier Court tj <br /> i . Motel 0 Other. . ....................... <br /> Number of living uhi`ts:..1.. ... "Nurriber of bedrooms L-.....Garbage Grinder .�°..... Lot Size -k--'Z2 W .......... 1 <br /> Water.Supply: PUIOIc Syste> `and name ................. ......................-..................... .........................Isrivate <br /> t Character of soil to a depth of 3 feet: Sand 0. Silt 0 pay 0 peat 0 Sandy Loom 0 Clay Loam p , <br /> .... . ..... ............... " <br /> ,Hardpan�. Adobe� hill N►aterlal ....... .ff yes, . <br /> I iPlot_plan,,showing-mace 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,) <br /> PACKAGE TREATMENT" ),. .SEPTIC TANK I ] Size-.4-............ ...... .... ....... Liquid Depth . � <br /> iCapacity ...:......� Tyi4 . ..... . Material.................:... No. Compartments ........... . <br /> r � Distance to nearest: Well .. ......... ....Foundation .................... . .. 'Prop. Line .....:.. <br /> LEACmw LINE [ ] No of Lines ................. :-Length of each litre.::. :.:..:::............. Tatai Length . -i <br /> Brox'- `.. Type Filter Material .:............ .Qepth filter Material .... - y, <br /> c <br /> Distance to nearest: Well ............... ... Foundation --- ....... ...... Property Line ....... 4' <br /> f SEEPAGE PIT [ 1 Depth ........... Diameter .... Number .. ......... . Rock Filled Yes .0 orf Na Q <br /> Water Table Depth ............. .. ......... ...................Rock Sirs ............ .. f <br /> Distance to nearest, Well ........................---... .........Foundation .................... Prop. Vne .........:.... <br /> "REPAIR/1&D1TiON$Prev. Sanitation Permit __ Daft -- . ............. . .l <br /> Septic.Tank t(Specifyr Requirements): - -._... •----...•...... .... ... . r..--•- <br /> L <br /> Disposal Fielc! j5pecify Requirements) __... ..�. • �- 3�. ''� r �- 400n���^.. . <br /> .: . ' ... , .... 1 •- ....-.. ........................ <br /> r ... .... .. ................ .. ................................ .. . ........ . <br /> .--- ....... .. _ .... --- - ------ <br /> (Draw existing and.required addition on reverse side) . <br /> I hereby certify that 1 have prepared this application and that the work will be stone In,accordance witb Sm.*WqQ in <br /> I County Ordinances, State Laws, and Rules and Regulations of ;the San 'Joaquin Local Haahh.4100- Hausa evinm trr VciW <br /> sed agents's ig nature certifies the following: ` <br /> "I certify'that in the performance of the work for'which this pernsit-is issued, II shall not employ any parson lie sacs rrtastnar <br /> as to become subject to Workman's Coatpensation laws of Californla, s� <br /> Signed .................... j Owner <br /> Title <br /> (If er than owner) <br /> FOR DEPARTMIINT USIE ONLY <br /> APPLICATION ACCEPTED BY _...----- ---••--------------.......------------------------------------••---,..-- ---- DAT€ ..-.. : .... .,.7.5.+...:..:.:.... <br /> BUILDING PERMIT ISSUED ...............I------•• ..................... DATE <br /> ADDITIONALCOMMENTS ........................................................................,.,...................:-•---.._...._..---------......__._.,_,---_...._-.........._...._ <br /> r ....................° ....................... __....._._...•--._... , ..... <br /> _._ .... ... ..... . ..._1­ <br /> ti a ------------er <br /> .___ l --------- ---------•---._.........._- v� ....__ _.._ ._.....--- .............../ <br /> I Final inspection by: .............5:.1..i._......_-. ........_.. -- .........................---•-..._.- _..-_.....................Date ...-_._ <br /> ' _/ <br /> EI x3 2!a ai-68 <br /> Rev. SM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71J 3M <br />