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V FOROFFICE-USE: <br /> .. <br /> i' APPLICATION FOR SANITATION PERMIT <br /> ......... ..........................:.......•-•--•.._... Perm€t No. ---- <br /> [Complete In Triplicate) ....... <br /> ..... _ ------------------------•----•-- Date Issued �� 7s <br /> This.Permit Expires I Year From Date Issued "" <br /> Application is hereby made to the San Joaquin Local Health District for a -permit to construld and install the work herein <br /> described. This application it made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> k- JOB ADDRESS/LO N ---C9- -��. i".?G.. _4r, "'.. `G"!........."....CENSUS TRACT ............ <br /> Owner's Name '4 +-...:_. t�'! .., . .. Phone . .... <br /> --•. .......... ............•---- .................. ...... <br /> Address .. !Y>..'CR..... .... ..................City .A.?.-Y.2 '......••. <br /> Contractor's Name <br /> ,�4/�•�-,..�.au�rs �e�l! •`G,nG---------------License # �,�.._'.T Phone ��..._.�....o'�'. <br /> Installation will serve: Residence Apartment House❑ Commercial3flTrailer Court ❑ <br /> u <br /> Motel ❑Other <br /> g Garbage Grinder IYC.w5 Lot Size ..SC7. .5'........_ <br /> � Number of living units•_�.__ Number of bedrooms ... _..__ <br /> Water Supply: Public System and name ..............Private <br /> Character of soil to a depth of 3 feet: Sand X Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan I] Adobe❑ Fill Material ......-..... If yes,type <br /> qr 31 <br /> (Piot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 11j <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , AV <br /> PACKAGE TREATMENT [ l SEPTIC TAN Size... 1 >x.�ct........................... Liquid Depth ... . <br /> Capacity ..._ TypeYA 'I._ Materlat-- Yl0.44No. Compartments _. ............ <br /> Distance. to nearest: Well .115 �:_.-•-•.-........:.Foundation ......... Prop. Line <br /> LEACHING LINE [ ] No. of Lines _. ............. Length of each llnea3......7.7..... Total Length J.4;9_*_............. .. <br /> 'D' Bax k- 0, e" <br /> .. Type Filter Material ...I...-Ze........Depth Filter Material ......-".Y..............................7- <br /> Distance to nearest: Well ------------------------ Foundation ........................ Property line ........................ <br /> umbeDepth l_.-.... Diameterr ...._...�Z..__..._.... Rock Filled Yes No Q <br /> uyV.r7- • <br /> Water Table Depth ................... ...........................Rock Size Alk,-------------------- <br /> Distance to nearest: Well ....foundation .................... Prop. Line ....................... <br /> ` REPAIR/ADDITION(Prev. Sanitation Permit a# --......_............................----- Date ........................... <br /> SepticTank (Specify Requirements) .................................................-.............................-.._......................__........_...........I............. <br /> Disposal Field (Specify Requirements) .-•--------------------------------- ....... ........• ---------..........-.............:............- .................. <br /> "---------- ------------------------------------------------- -----------------*---------- <br /> --------- .--..-•-----...."­------- <br /> ------------------------------------------ <br /> :----------------------------------- <br /> ..................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with.San Joaquin • <br /> ! County Ordinances, State Laws, and Rules and Regulations of the San 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 thispermit is Issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws.of California." <br /> Signed --- -------- Owner <br /> LQ <br /> By --- --- . --- -- . ----..._.... Title ---------------- ------- <br /> ------------------ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY --- ...... DATE ..... <br /> IBUILDING PERMIT ISSUED -------------------- ----------------------------------- .............. -----•-•-•------..- ............DATE -...-...---•-• ------- --- .......... <br /> ADDITIONAL COMMENTS -----------------------------------------------------------------------------------.-------- -- -n........ ........... <br /> ---------------------------------- __----------------------- ---...-..-------•------•---•--------•--...._......-----------------..:..-------- ............ <br /> ....._........................................... :. ._... ........_................._................. ..... :y.,..._.. <br /> Final Inspection by ....Date ---------/.:.�.Y..` ...:......... <br /> 1H 13 2h 1-68 ft-_v. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />