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n <br />FOR OFFICE JUSE, <br />----- ------------------------------------ <br />------------------------------------------ <br />................ ---------------­ --------------- <br />0 <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) - <br />This Permit Expires 1 Year From Date Issued <br />FILE POP <br />Pei <br />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 Rules exi tin <br />s i u es and Regulations: <br />JOB ADDRESS/LOCATION ...... ....... ...-... CENSUS TRACT ......_L2__•----------- <br />Owner's <br />......6­1----------- <br />Owner's Name .... 1&___J ).Vo A. .. �Piy ........... I ........... ..................... ---------- ---------Phone — _----------------------------- <br />------- ---- <br />Ad <br />dress ------- 5 <br />Contractor's NameYL ... 5Q1.V ................. I ----------- License# Phone <br />Installation will serve: -Residence EN Apartment House 0 Commercial :[DTraller Court <br />Motel [:] Other ---------•---------_-------------•----•--- <br />Number of living ijnIts.-_j ...... Number of bedrooms .__::F.._.'.Garbage Grinder MA.__-. Lot Size <br />Water Supply. Public System an8 name <br />----- -------- ;_-1 ------------ ---------- ...................... 11 -----------­------------ -Private 0 <br />Character of soil to a depth of 3 feet: Sand;'] Sift[] -Clay ❑ Peat E] Sandy Loom 0 Clay Loam E] <br />- If yes, type - <br />M-0 _----------------------_ <br />Fill Material.. <br />Hardpan ❑ _,�Adobe J_ <br />I t plan, showing size of lot;jocation of 'systern in re ation"ta wells, buildings, etc. must be placed on reverse side.) <br />NEW INSTALLATION: (No septic tan k,oe�seepaqe pit,permitted -if public sewer is available within 200 feet,) <br />1% 1 1 fs <br />PACKAGE TREATMENT SEPTIC -TANK -f --------- <br />'r . Size. ------------- I ---------------­------- Liquid Depth t <br />CapacitY, I , - ------- c ------ ..-. Material ------------------- - No. Compartments' <br />------------ Type ..... <br />Distance".to nearest: Well ______....i________________________- Foundation ------_--------------- Prop. Line..... ........ <br />LEACHING LINE. No. of Lines* 7 ................ ...... Lengih of e&h'line ---------------------------- total Length - -------•-•-•--------------- <br />- <br />-------------- ...... T <br />Type Filter Material ____________________ Depth Filter Material ......................... .......... ; <br />Eistciii6e to nearest. Well'!" 0 a. <br />................. F undiCitio"n' ------ .... Property Line ............... . . <br />. ....... -Filled Yes 0 No:.C-� <br />SEEPAGE PIT Depth -------- Diameter _'__'­_�n_:!7"Number ...... ....... Rock <br />VF Ij 'j, ! , " <br />Water 176ble Depth-. ............ ------- ........ ---------- i -------- Rock Size --------------------------------- <br />'. <br />Distance to neOTe$t;. We .- <br />-- roL;Wd;tlon ............. PropLlneT. ...... 1.� m ...... <br />-.REPAIR/AOPITION (Prev. Sanitation Permit # ------------------ Date ... ........... ;� ----------------- <br />I - A .. <br />Septic f�nik (Specify Requirements} �Al --- FA A/_'t ---- ---------------- ----------- --------------------------------- ---------- <br />Disposal Field (Spec) Re"q'uirements) ...... 5p�._!V~_ .. ----------------------------------------------------- ------- <br />........... S ------- ........ -------- ;? V . <br />------------------------ <br />_­_A_./_,r!q_A_1e_" ......... ��Z------------ <br />DAC ..... UEAc <br />(Draw existing <br />required addition on reverse side) <br />I hereby certify that I have prepared this application and'th at the work will be done -In accordance with Son Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin <br />a';uln Local Health District. Home owner or licen- <br />sed agents signature certifies the following: f - <br />"I certify that ;n the perFormance of the woric for which this permit Is Issued, I shall not employ any person in such manner <br />as to become abject to Wo an's. Compen tion laws of Calife7mia... <br />Signed ....... �A, ---- - ­­ ----- - ........................ Owner <br />----------------------------------------------- <br />By -------- ----- --- -------------------- ------------------- Title ----- <br />i I t -------------- -- <br />f other t'It2in- <br />FOR DEPARTMENT USI- ONLY <br />APPLICATION ACCEPTED BY._777j..Rz.0:� ........... <br />----- --�� -------------- DATE ------ <br />BUILDING PERMIT ISSUED -----------'------------------- e0v <br />ADDITIONAL COMMENTS ........ ........... ..-DATE ............................................ <br />-------------- ---------------- ------ .. ...- <br />a <br />................ / - �: ---------------- I ........... ------------------------- ­_­ ----------- <br />------------------------------------------------ <br />------------------------------------------------------------------ _ --------- <br />------------------------------- ­­ - ------- - ------ f -------- <br />�7 <br />---------------- ............... -- I ........... .. ------ -------------------------------- --------------------------------------- <br />7- - ---------- -- ---- -- ----- ------------ ------------------------------------------------ <br />tt <br />Fine] Ins ection by: ---------------------------- Date ....... . ---------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1 -'68 Rev. 5M <br />