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r <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> '�- .........7 <br /> --------- ------------------------- -------------------- <br /> - Permit No. <br /> - ---------------- --------------- - (Complete Triplicate] ���73 <br /> ------ ------------ Date Issued -- ---------------- <br /> This Permit Expires 1 Year From Date 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: <br /> JOB ADDRESS/LOCATION .__;?,0Yq.2-------- <br /> --- ��f- O------SWERS-------A->.----CENSUS TRACT __ = ~�------- <br /> Owner's Name ---------,��Rr-------V AC— ---------D- '�------------------------------ -------------------Phone ------------------•----------------- <br /> /� <br /> Address __.L ��--------15-- ��-10------ ��__���-,__. City ------AITC --------------------------------------------------- <br /> Contractor's Name --------a9wy%/- .- -- -- -----.License # -------- -------------- Phone --------------------_------- <br /> Installation will serve: Residence ❑Apartment House,F] Commercial []Trailer <br /> Motel ❑Other ------ ------- ---------------------•-/_P__5Number of living units:_ ------- Number of bedrooms ---I____.Garbage GrinderLot Size __f7 f ------ <br /> Water Supply..jublic System and ------------------------------------- <br /> ----- <br /> name --------------------- - -----------------------------------------------------Private <br /> Character of soil to a depth of 3 feet Sand ❑ S' Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> =Hardpan` Ado�wF1ll MatA e�alb-I------ If yes,A+r pe --------------------- <br /> (Plot plan, showing size of lot, location of system i ation to wells, buildings,betc ust be placed on reverse side.) <br /> NEW INSTALLATION: {No septic tank or seeps pit permitted if. public.—sewer is available within 200 feet,) f c <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ Size.h_t_: ._ �-X,, ------ Liquid Depth ----�_---____________ <br /> cit � -P ^CA�Material__eama tpartmentsCa j <br /> istance to near. st: Well __----� _ Foundatio n-----1� --- Prop. Line --_�----- <br /> LEACHING LINE No. of Lines ---- ------------------- Length ofi'each,Jine��__��--=----- --- Total Length f ------7�-�------- <br /> a 1 <br /> -- -�-- I <br /> ' Box W�_____ Type Filter Mat�rjal -���t���Depth Filter Material __ ___ -- _____. � -- U1 <br /> r... <br /> -.1�.c� Property Line S .� <br /> ZDepth <br /> stance to neaie T Weli -:` -11__:'_'"�""'-Foundation ------- ---------------- -------------•--. ---- <br /> SEEPAGE PIT, __ Diameterf�X-l_�- Number ________ __________s_ ___ Rock Fil d Yes �o ❑ <br /> cd <br /> .t = v.Water Table Depth -- ..------- Rock Size __0_ _S_--��?,:�­ <br /> Jt <br /> 1 <br /> �.� r Foundation /10--______ . Line ..-. <br /> + � ` Distance to nearest: Well ______r__- <br /> - --------- - -------- <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) G <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ---------------------------------------------------------- <br /> Disposal Field (SpecifyRequirements) ------------------------------- ---------------------------------=k <br /> ------------ <br /> --------------------------------------------------------- <br /> ------------------------------- - ---------------------------------- <br /> °- - .___ _d_---------------------------------------------- <br /> 6 <br /> _________________________________________ —_ <br /> (Draw existing and required addition on everse'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 signatu a certifies the fallowi <br /> "I certif in a pe mance th work for which this permit is issued, I shall not employ any person in such manner <br /> as to b ect to orkma pensati.on laws of California." <br /> Signed - - -- ------------ 04-L--- -- Owner <br /> — Title -----4:_5------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- -a-R - ------------------------------------------------------------------------------ DATE �------ <br /> BUILDING PERMIT ISSUED ---_------ <br /> ----------------- --- ------------------_--=-------- <br /> -------DATE ------------------------------------------- <br /> [• _ - --------------- <br /> ADDITIONAL COMMENTS ----- -­= ---------=--= — --------------- <br /> - <br /> ------------ <br /> -------------------------------- <br /> '�-- ----------------------------------------------- <br /> rDate -- - ------Final !ns � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />