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41 <br /> FOR OFFICE tJSI=: APPLICATION FOR SANITATION PERMIT <br /> Permit No.��F -------------- <br /> x t. (Complete in Triplicate) i :--:------ <br /> r. <br /> z This Permit Expires 1 Year From Date Issued Date Issued _ ___ ___ <br /> 'plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the4 work herein <br /> scribed. This application isz;inade incompliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> CENSUS TRACT ___ ----- <br /> �h . tB ADDRESS/LOC filO�l _ _ ;�-_ - -- ,� <br /> -..' <br /> j+( <br /> Ph <br /> Owner's Name = E one <br /> �,I]� <br /> ------------I--------_, city <br /> Address �� `T--------- -L-C <br /> ------------- <br /> ----------------- -------------- ------ <br /> ' Contractor s'Name i _l y 3 7 Phone _ _-!s'� <br /> �,. _ - - -__-'-- ---.{License #��--- --------- ,N ----------- <br /> Installation will serve'. Residence 54 Apartment House-E] Comme","rciaf ❑Trailer Court 0 <br /> rr Motel ❑Other -------------- ------ x' ' <br /> Number of living uni#s:--_!-____:_ Number-of-bedrooms--:___1—:Garbage.Grinder Cot Size _ _ _ l I e,,._________ <br /> Water Supply: Public System and name----------- ------------------------------------- ------------ ---------------Private <br /> Character of soil to a depth of 3 feet;.�,,5and-g, Silt-, *rClay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> ,.,. <br /> Hardpan ❑ s Adobe ❑ Fill Material Na-- 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.) <br /> NEW INSTALLATION: {No septic-tankf or seepage pit per-rrriitte-d-if--pyb`ic-sewe-fie a�va€lable-withi n 200 feet,) <br /> PACKAGE-ETRE-ATMENT [ ] SEPTIC TANK r { Siie_.__ ___ __ ____.______t___._ Lic aid Depth _.__ _____________ <br /> Capacity lv4-5,;-- Type '--- -----�----- Material--- ------ ----------- No. Compartments ,---q7--------- <br /> - <br /> Distance to nearest: Well -�� --------------------------Foundation ....le-------i:___ Prop. Line'-__J-__� - _--- <br /> LEACHING'LINE [Q00""No. of Lines _--_-__2-_____ __-!_,Length of each I1ne____ 7V_-_� Total! Length ____- a_ ----_____ <br /> /� - r <br /> f V <br /> D' Box __-_________ Type Filter Material)l �lY/___Depth Filter Material _f___ d____--.-_'------------------- <br /> 1_5 <br /> ___R;_y__.__:__ <br /> k Distance to nearest: Well __�c�_ ----------- Foundation _A-00------ Property Line __J�_______.,.___ <br /> SEEPAGE'PIT Depth 3 <br /> [ l P Diameter Number ---------------------- ---- Rock Filled Yes ❑ Na jo <br /> Water Table Depth \ \ _ _ Rock Size ___________________ `_________ �• <br /> Distance to nearest: Wel ----------- —N ----------------Foundation ----------------`'t Prop. Line s_--- ..---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------- ------ -- Date Date ______________________________-_) <br /> Septic Tank (Specify Requirements) -------------------- ----------'--------- ------------------------------------------------------- --=- <br /> Disposal Field (Specify RR quirements`)"* °_____________--_ <br /> _____ <br /> ------ --- <br /> ------ ------------------------------- --------------------------------------------------------- <br /> F <br /> ♦ ' <br /> __________________________j --------- _ -------------_----__----- _______-_________ __------------------------------------------------------------.____________________ <br /> r {Draw ex€s-ting a-- d required addition s reverse side) <br /> I hereby certify that I hav6repared this application and that the work\will be done in accordance with#San Joaquin <br /> County Ordinances, State Qaws, and Rules and 'Regulations of theSan 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." <br /> Signed € caner J <br /> - Mme; <br /> By � c IC " '� f - Title -------- ----------------------------------------- ------- -. ------ <br /> - --- <br /> (If other t n owner) 4�_ <br /> FOR DEPARTMENT USE ONLY ! <br /> APPLICATION ACCEPTED BY ----- 4 > ___= DATE <br /> BUILDING PERMIT ISSUED -------------------------------- --'-------- " <br /> - - -- -----DATE ------------- ----------------------------- <br /> .ADDITIONAL COMMENTS _ <br /> __ - -- - ---- ----- ------- __p--- --__-------------- <br /> ------------------------------------- -------------- _ -__--------------------- ---------- ----.-- <br /> -- - ------------- <br /> -------- <br /> ---------------------------------- <br /> R - - -- ---------------------------- <br /> ------ -- - - ----- -" Final Inspectio � - --- -- _ <br /> - --- -Date ---- - . <br /> r" SAN JOAQ LOCAL HEALTH DISTRICT <br /> F <br /> E. H. 9 1-'68 Rev. 5MVii` ' /. r <br />