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rvx Urru,t vacs <br /> -°--APPLICATION,FOR.SANITATION PERMIT <br /> ........................ .. Permit No. ._Z�:.73-'�- <br /> ` Triplicate) <br /> .............................................. Kam leteln Tri Date Issued . -d - G <br /> •. This Permit Expires I Year From Date Issued <br /> ... !'.. <br /> E <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> F described.This application is mode In compliance with County Ordinan a No. 549 and existing Rules and Regulations+ <br /> JOB ADDRESSA TI '`r•� e.. ..... ... ...................... ----------.............................CENSUS TRACT ...... ............. <br /> Owner's Name . ................................................... hone ................. <br /> f <kddress <br /> ..... .. (��.4_.. � 1....... .............. _city _ <br /> Contractor's Name . A ..... .................. ......Cnl .license# <br /> Installation will serve: Residence gApartment House(3 CommercI&I QTraller Court 0 w -' <br /> / Motel❑Other ` 1y ii <br /> Number of living unttta.... Number of bedrooms C-e.7 Garbage Grinder ............ Lot Size . ? ... ....................... <br /> Water Supply: Public System and name ..................................._............::..................._..........................------.fivi"te,,�` <br /> Character of soil to a depth of 3 feet: Sand n $0t❑ Cloy Q -Peat❑ $andy Loam 0 Clay Loam <br /> Hardpan D Adobe o Fill Notarial............If'yes,type.................._....... <br /> IPlot pian, showing size of lot, location of system In relation to wells. buildings, ett must be placed an reverse side.) <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if publk sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( J SEPTIC TANK>;1--' S � .. .ems....:............ liquid Depth ............... <br /> Capacity,to -... Type�!-° MaterlaK..: IKt........ No. Compartments ...X2— <br /> Distance <br /> ..c2Distance 'to nacre Well ... -•...................Foundation,,�c%�..---_-• .. Prop. Line J`. .._ ....... <br /> TEACHING LINE [ No. of Lines ........ .............. Length of each line. �......:.... Total Length ...1y ..�.... .. <br /> D' Box ............ Type Filter Materinl .. I.11`Depth Filter Material .........�,�{f...............,.. <br /> ',, r r <br /> •k - Distance to nearest: Well ,I�....-. -. Foundation ..�............ Property Line .. ...... ..- <br /> �r <br /> SEEPAGE PIT Q Depth ..02. ......... Diameter - .......................Rock Size .?.._..__ Number ......./.........I...., ltoc ill Yes No <br /> Water Table Depth � <br /> n. <br /> E � fi --•-•---._..... .�. .... r <br /> i � <br /> Distance to nearest: Well ---...6�RVV--'...................Foundation ..Ize........ Prop. Line Jam. ....... <br /> REPAIR/ADDITIONIPrev. Sanitation Permit# ........................................... Date . ............._.......1 .. <br /> Septic Tank (Specify Requirements) ..................-......._._.... .._.. ................ =�.......... ...... <br /> Disoosal'Field (Specify Requirements) .......................---•-------.........................................I............................. <br /> ( <br /> ..................................................................................................................................................................I....................... <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 to ac anlana with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local health DisirlN.Nome owner or!Icon• <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 10 such manner <br /> as to become bj t to Wo on' Compensation laws of California." <br /> i <br /> :::gnec .^ ........... . ._...._....._..._........_..:._Owner <br /> By ............... <br /> ......._. Jitle ........... .................. .................. <br /> (If oche than owner} <br /> E R DEPART ENT LISk ONLY <br /> E <br /> APPLICATION ACCEPTED B DATE .... �_........ .:.. ..... <br /> BUILDING PERMIT ISSUED .. --..DATE,- ............--•--............. ......... <br /> ADDITIONAL COMMENTS...... ..........:........................... ............—/......--*....... <br /> _. . . .:.. _....._-............................................................................. .... .....................................I.................. .. <br /> Final inspection...... .... ...... . ._.....-......... ...........--................... <br /> .. .. .:✓.,...._............: ................................Date ... . :.. l`. ..-_....... <br /> ... <br /> �•�r ... <br /> by: ..... ........ l_........ ...... .. . .................... <br /> • lei 13 24 1-68 Nov. SM SA N LOCAL HEALTH DISTRICT 8!717 3M <br />