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. ....r�� C <br /> urrr►�.� • . <br /> AMICATfON FOR SANITATION PERMIT 77 <br /> . { .. .. ....................................... �� (Complete in Tripilcote) Permit No. .......: S`c <br /> ..... ...... ..... ..................... .... .. �..... This Permit Expires 1 Year From Date Issued <br /> Application 1s hereby made to the San Joaquin local Health District.for•.a ;perniit`to construct and Install the work herein <br /> described. This application is made In compliance with County•Ordin-pnce-No: 549-and viditing-Rules and Regulations: <br /> JOB ADDRESS/L �ON ;. �?,.. .fT .........:.. . ..... .,.................:CENSUS TRACT <br />' Owner's blame ., .. . ..� ............................................................� Phone ...�5 ;F <br /> 7-- <br /> Address lam- _ --- -- ..1!.-C.f.:..._`� `-� ` yj �h� .............................................. <br /> Contractor's Ncsne !'"�� . ........License # Phone <br /> Installation will serine: Re dance partirtent Housefl Commercial❑frailer Court ❑ 1 ; <br /> f .I Motel❑Other. ' -G`;� ------------ <br /> Number of living unitar:..........:. Number of bedrooms ._�..._ arbage,Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name .. ........... ._ .............. .........._.......­ .................................... <br /> .•...............Private er'' <br /> r <br /> Character of soil to a dapth�h f 3 feet: Sand❑ Silt❑ �Clay�Q 4, Peat Q Sandy loam O Clay Loam❑ <br /> fi Hardpan Q Adobe❑ fill Materlal ..'_.........if yes,type............. .......... i <br /> E (Plot plan, showing size of lot, location of syster+ii In relation to wells, buildings, etc.,moat he plaited onr reverse alder# <br /> NEW INSTALLATION: , (No septic tank ortseepage pit permitted if pubilc sewer,`Is ava1i0ble-w1th1n_200 feet,) �l <br /> i PACKAGE TREATMENT { ]� SEPTIC TANK{ ) % Size....... .:.:...................................... liquid De0h .................. .. <br /> Capacity jo ................. aie�ial .... No. Compartments ... - _.... <br /> .. - :- <br /> ' ---�` Distance to nearest: Well :. ..............Foundation ! Prop. Line ../p <br />`. LEACHING LINE { { NoM of,f,Lines .-�•,.�.................... Length of eachl 11 e.. / ..... _. Total Length �� .•(-~•.... <br /> `D' Boz `--.---- Type Filter Material ..Depth (Filter Material .. .L... .................................. <br /> Distance to nearest: Well. 11 .............. ..... Foundation .... Property Line ........................ <br /> .. .. .... ... <br /> SEEPAGE PIT. { j j Depth °...-•---••----..._.. Diameter .......1.-...... Number ---...... ................... Rock 'Filled Yes ❑ No Q <br /> Water Table Depth .......................Rock Size -•-- ............................ E <br /> i <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Vne ..........-........... <br /> a <br /> REPAIR/ADDITION(Prov.'Sanitation Permit ..................................... Date ..................................j <br /> Septic Tank (Specify Requirements) ................................................. ...... ....................... ......................E...... <br /> Disposal Field {Specify Requirements) _.. . ........................... -•---••----•................-_... . ....._....._...... . ...... .................. <br /> .......................... ..... <br /> .. .. :•... j ---------••---:--- . .._........--------......--------•--------.... ................................ ----.... ........................ ,. <br /> .. <br />` I (Draw existing and required addition on reirerse 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 tocol Health District. Horne owner or Iicen- <br /> sed agents signature certifies the fallowing: A <br /> "I certify that In the performance of the work for which this permit 1s Issued, I shall not employ any person In such manner <br /> as to become subject to arkman' Compensation laws of California." <br /> Signed . .L�- ...............................•--•--.............. .Owner , <br /> 1. <br /> sy ................ ..........................................�M .....----.--•-----•. ...............I..... ;T tiB ...... --- ............._.............................. <br /> .... <br /> f oter than owner) _ . <br /> FOR DIED RTMENT USE ONLY <br /> APPLICATION ACCEPTED .8Y .. ... ........................................,,DATE,... .._-/7..-- ........... <br /> APPLICATION <br /> BUILDING PERMIT ISSIlED 'I DATE .-.-...•.....................:.....:....... <br /> :...-•-........... ..................................... <br /> ADDITIONAL COMMENTS '` <br /> .---....-•---"..........................••-...._............ .....-- ------......... ............._...-.....-..................... .................................................. <br /> ................................... ..................................... ..................................•...............................- ---.--.............................................. <br /> .. ........... . <br /> ..... ................. <br /> Final Inspection by ....... � •- -- .-..... .._..._.... Date --'7.. Z>.,.. �................ <br /> Mi 13 24 1-68 Rory. � <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT 8/71 3M <br />