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FOR OFFICE USE: APPLIC TION FOR SANITAVON PERMIT <br /> `, - Permit No <br /> --t. (C p1M 4in Tdpil<otel <br /> ...... . . ... ...... ..... .. ... . .... —"_: - , <br /> Date IssuedG.. -26 7D <br /> .............. ........_................................. This Permit Expires 1 Year From Date Issued-_._._.-�.. <br /> Application is hereby made to the San Joaquin Local Health District fak a perml! to construct and Install'thework herein <br /> desaiLed. This application is mode in complionca with County Ordin nc, No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION .....SC} ..._ ._.... ., . . •... . __.__..._....CENSUS TRACT <br /> , TRA'!......7 <br /> ..... <br /> Phon .. <br /> Owner's Name ... . <br /> Address ...�� a .fie-v<- .........................f. city . ............ . Ci .. <br /> Contractor's Name ...... _ -.-- ... ..License -.... . Phone m,66 S6A.7•.- <br /> Installation will serve: Residence XApartment House❑ Commercial CTrailer Court 0 <br /> Motel ❑Other_............._...........__.............. <br /> Numbor,,of living units:...I...... Number of bedrooms ../........Garbage Grinder ...... ..... Lot Size ....._...... _.......... <br /> Wutor S�'�,[�s ublic System and name .........................................O..........._........................�.._.....y......Priv <br /> Character of�to a depth of 3 feet: Sand 0 S�ift!f1 Cla Peat Sand Loam <br /> CIO loam <br /> Hardaart ]',+'Sliltibari _Fill Material . .. ....If yes,type.. . <br /> Mot plan, sho,. .size of lot, location of system in relation to wolfs, buildings, etc. must be placed on reviiirse side.) <br /> ' NEW IN+'� Ohf: (No septic tank or,seepage pit permitted if public sewer is available within 200 feet I 't <br /> PACcA�� T nENT�7 SEPTICTANKj ] Size.........I......... ........... Liquid Depth _...... ................ <br /> t` ................ <br /> [ Cap6city, .... ..... ... type ........ ......... Material. .... . ............ No. nfs .... .. ... ... <br /> Distc{r�� in rkarest: Wel! .".`_..".`..:�.: ounTatlo ......... .. ..... roP.�ino .... ......... .- <br /> . <br /> ' . . 'N ...... Tout C .. <br /> LEACHii.G LINE O No. of Line-, .... . . ... . LIngth of each lin@+it'.: . ... . � ��- <br /> `— 'D' Box l fi <br /> lt <br /> er Mdterial .........._........D prIt Fllt r Materl I •••-•---�••••----• -• ` <br /> Distance to nearest. Wait ............ . Fou da I i .... ............. cperll n ......iii........... ... <br /> SEEPA E PIT [ J Depth 1�.,.�.�... jL r ,-.. ..... Number .... ...... ...... .... ock fit Yes ['] No Q <br /> y pao% Os�r <br /> � d Rock Size. ............. <br /> Water i ... ( ..... <br /> .... .. .......... { <br /> Distance to ne s We!I1 -+---7-- -- ;wndatio ........ ......... Proq }Ints . .............. <br /> VEPA-41AMIION IPrd ... Date ............. ........ .......... <br /> Septic Tank 1Specify Requirements) J............................................._.............................._.._....._............_.... ............ , <br /> Dispo:al Field Necify Requiremeennt¢)�yn .. _. ......1'........y......... .... ... . .. ..... .. <br /> C .../ ...... .._.. <br /> .... .. . .... ................. ..................................... . .... . _ ..... ......_._. <br /> (i)raw existing and required addition on reverse side) _ <br /> 1'rCerebY te+t�fft' r7r'alTL<o Pnsjurci-liifs epplfca on an fh aT tTii work wi7f'6adoni'in a7cerda`n�e`wH6-Yen Joaquin ry; <br /> Count' and Regulations of.the San Joaquin Local Health District. Hem*owner or Ilan- „t <br /> sod agents signatum cemfies the fallowilrg: <br /> "I certify that in theerf0 n ca of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to neon's Compensation laws of California." ' <br /> ' Signed ... - {}i},�_ . . .. .-Jitlener _'�-•e._. <br /> By . owner) _.... - . ..... r <br /> (lf other txort�owreq <br /> (((((( FOR DEPARTMENT USE ONLY 'l <br /> APPLICATION ACCEPTED BY.._..lb<`..'' ,/..!`•''_................... ............................................, DATE...2.-��a.:.'�. ....... <br /> I: <br /> EUILDINCPERMIT ISSUED ...... _._............................_.............._.......__. ...........,.......... ..........DATE.................................I.......,. ' <br /> • ADDITIONAL COMMENTS................. .........................................................................................................._............. <br /> ................._ <br /> .ecil.... . coo <br /> ................ ... _. <br /> Final Inspection by: . ... __...'!r fir•........ ...............................................................Date -7 r..f7f ? ..... .... R; <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'68 Rev. 5M <br />