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oF06+ FFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ................................................... Permit No. ....7�....�° <br /> ................................................ ... <br /> (Complete In Triplicate) <br /> .................................................... This Permit Expires i Year From Date Issued <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 existing Rules and Regulationnss: <br /> JOB ADDRESS/LOCATION�.21 -,33.5..- 4.4E-......R_[.vaR......RA--...........................CENSUS TRACT ... `. .[..:.... <br /> Owner's Name ...........l-�J4Z"A' _...--....a.��.., I.t�-pQ-,.......................... ........ :. ...................Phone _... ............................... <br /> Address .........2 t. tea» ........ ........Cl.).V ......G13.{.... ......... City ... 'Erp.c..:--.................................................... <br /> Contractor's Nome ........410WAVVMIX. ....... .............. ..................................License #j....:.;1................ Phone .............................. <br /> Installation will serve: Residence f (APartment House Commercial ❑-T ro.`ierCJrt <br /> Motel ❑Other........ ........................ .... 1 <br /> Number of living units:... Number of bedrooms ... __:..__.Garbage Grinderts Lot Size .t�.- fS'- A.�i <br /> Waterr-Suppiy!Public System and name ................ I... ---------------------------------_____!_...-Arivate <br /> Character ofXanil-lois depth of 3 feet- Gond❑ St Clay ❑ Peat❑ Sandy Loom ar-'661 t'obm �a <br /> Harapgtt Adobe•❑ Fill Material .. .. .P- If yes,type ---------------------------- <br /> ,Plot <br /> -- --- ------ ----- -(Plot plan, showing size of lot, location ofsystem i relation to wells, buildings, etc. must be placed on reverse side.) <br /> ^'NEW INSTALLATION: (No septic tank or see pit Permltted If public sewer is available within 200 feet,► i <br /> ` PACKAGE TREATMENT ( J. SEPTIC TANK l Size.,?�X.Id. �(..�................ Liquid Depth .... c rte?................. L <br /> Capacity 1,620- <br /> Type�1 Cf�$TfNaterial.CQ/-!>'4�No. Comportments .....1 �........ <br /> f istance to neorest: Well .rf..... .1�. ....:'..:..... ..Fourid Aon ,l 't ` Pr; .br;o-1-5... <br /> t <br /> LEACHING LINE [ No. of L�,i,,n//es .......d�.............._Lgngth.o`ff each line........./00......%Total Length .......�._Q_....�L. <br /> �'D' Boz ytC Type' Filter Material ,BaCA�.Depth Filter Material .........,/.-.C,>7._..... ..I...._... 6 <br /> Distance to nearest: Well .......:�f�.+ . Foundation .. -7` per* Line ..:........... <br /> / c.� f-�...-..i:----.. Pro r <br /> SEEPAGE-PIT--[- Depth=- �•;./.......-i Diameter .-Z.9- Number ....... —. - -..y Rock fi led Yes' No <br /> Water Table Dt+ptFi. �..�......�""'-�....-_:-J.......Rock .s— r <br /> Distance to-itearest: Well .......1.110._...._�.........Foundation. .._�Q..-.-_._. Prop: line .�.'t:... <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit tft ............................................ Date ......................_ .jI ,. <br /> Septic Tann-{-Wp ccify Requirements) .............................._.....................:...........................:..G:.............................:.................. <br /> . <br /> Disposal Field [Specify Requirements) . <br /> .............................................................................. :.....:.......................r................... <br /> ............................................-------------------------------- <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 in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horn' tiw`n'ir or liten- <br /> sed agents si ture certifies the following: t i t r <br /> "I certify th ' he pe ormanc a work for which this permit is issued, 1 shall not lmploy any parson'irt•'such manner <br /> as to beta ject t orkma am Icon laws of California:' <br /> Signed ....- -. .. x.41., Owner <br /> ................... ..... y.. <br /> By _...............(Iffo.. . -.-.ther-_.-th--.an ownene......-.. -................ 7:� 0 <br /> : . Title :.................................._.. ................................. <br /> r) <br /> FOR DEPARTMENT DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .....`r.tHAD.-s.................. ....... . ....... `..... �i------- ...... ...�,L.�.-7�j....... <br /> BUILDING PERMIT ISSUED ......... . f a`._�_'_._<r'`......----DATE ............................. - . ..... <br /> ADDITIONAL COMMENTS ............ . ...................... ...: .................:,:: ' --i <br /> ........................................ ..... : . ':. ....... .. `-.... '-•--..........._........................................._..... ................. <br /> ................... ............... ..... . . .. f <br /> ............................................ <br /> Finallnspection 1A.. '.................................Date .... ...^....... .... .............. <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT 11.1-76_73 <br /> E. H.13 24 1,'68 Rev. SM TI�r V7/72 3 M <br />