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F FOR OFFICE USE: <br /> PLICATION FOR SANITATION PERI <br /> ---------------------- ------------------------------ j Permit No. <br /> . " (Complete in Triplicate) �+- ----•� <br /> This Permit Expires l Year From Date Issued Date Issued <br /> ------------------------------------------------- <br /> Ap}ilication 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 ._-- I-29_I---- _--•til_I_ .P A?_D---------SC---------CENSUS TRACT 5-7-117....... <br /> Owner's Name ----------A-RT----- <br /> -----------Phone --------------------------- -----•-- <br /> Address ----1-7,30--------L)A:QK__ Q�------1 � -------------- - City <br /> Contractor's Name&$----69BE_f�(�AT-- -----------------------``�- :-'----.License # -.2-73-42 _ Ph n ---- _ <br /> Installation will serve: Residence Apartment <br /> lAMbtelir J�erHousP�r)DOqe <br /> i <br /> ❑Trailer Court ❑ <br /> Number of living units:.__ ______ Nu g W bed ms -- ------ <br /> i � . • <br /> Grindey,_A--.s Lot Size AuC -6---�.............. <br /> Water Supply: Public System and name ----------------------•--- -- — ;. -------- <br /> Character <br /> Private } <br /> Character of soil to a.depth of 3—feet. Sand'❑ " Silt❑ Cla Peat❑ Sandy Loam 400�alRam <br /> Hardpan Adobe ❑ Fill Material _1�- ___ If yes, ty -------- ------------------- <br /> i <br /> (Plot plan, showing size of lot,'location of system in relatiol�yl-to wells, buildings, etc. must be placed on reverse side.) <br /> 5L <br /> NEW INSTALLATION: (No septic tank or seepage p(t permitted if.,public sewer is available within;200;feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK, 1. Siz -- ------------------------- Liquid'trt <br /> Depth ..._ ______ }, <br /> Capacity VI-�_a.-- Type F-�E- `'�Matenah_'Q_ �1v� ._ No. Compments ._ ...:.......... <br /> Distance to nearest: Well/­:--_,S_0__ #i.. _Foundatio _��-t_____ i. p. -4...---.. <br /> ' "� Pro Line _ <br /> LEACHING LINE No. of Lines -------� L 'ngth P e6h 11' 0__* Total Length -------...-.-o---r---__-_ <br /> 3r I � t< <br /> D' Box _��-_ Type Filter Material _ _QCK___Depth Filter Material ____ i_..i-------------- <br /> C !. ,. <br /> Distan to nearest: Well i� _Q.__.-r _ ,oundat- f0___"�`______ Property Line. --- ---- <br /> . , <br /> SEEPAGE PIT [� Depth r______-____ Dia titer �X ' Num er __ _i 21-------- _ Rok Filler} Yg� �No <br /> Water Table __�= `...... ' <br /> ; . <br /> QQtion f - Prpp 4me .. i <br /> Distance to nearest: Wel! __ "� �_ Fund <br /> +s , <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------- '---- e -1 _ � ,_.. . " <br /> Septic Tank (Specify Requirements) ------------------------- --------------------------- --- ------------- <br /> Disposal Field (Specify,'R xre encs) .... _••-_.4l_ -3�-------1�1/sY'Q _--- <br /> = ---------------------------------- =- - ------ s <br /> ----------------- -- --------- -------- -- ---- -- - -------------------- -=------ ----- --=--------------------------- -------- ---------------• _.. . . <br /> >„_.(D,raw existing and require fadditi'aq�"n"reverse side) <br /> I hereby c rtify that ! have pre Led thisapplication.,and t. ` the;work will-be done in accordance'with San Joaquin <br /> County Orc inances, State Laws, and Rules and RegulationfFflie San Joaquin Local Health District. Home owner or licen- <br /> sed agents igna ure.certi€les the following: / .��� <br /> "I certify t at the per€ r anc4thek for which this erH+ibj sssued, hall not employ any person. in such moaner <br /> as fio b object rkm sa n laws of Ca iftrnj . 0 <br /> Signe -- - -------- -- <br /> -------------------­- Own C' <br /> 13Y --- - ---- --- s . 9 Title <br /> (!f other thart•ownerl0 �r �Vf �._ ! <br /> FOR DEPARTMENT USE—ONLY ` <br /> APPLICATIO ACCEPTED 13Y I t - ------------------------------ ----------------------------------------- DATES' <br /> BUILDING PERMIT ISSUED -----/_ _ _____________ _ DAT <br /> ADDITIONAL'"COMMENTS i'Q =1 �� �-'dt --..+e�!.e'r_l'b__.CQ ?"IZ ' �� t"�'-------------•-- --------- -- <br /> --- --------- ------` tErr ---- H ,+• mac' : yz-` ' ----'----- --- ----------------------- <br /> - ., <br /> ------------------------------------ -. __-_-__-_---________ _ -________ _________________� `----------__-_ ____________________ <br /> Final Inspection by: ----- - -- •Date . <br /> ._N_. MLOCAL'-HEAtTHW"DISTRICT <br /> E. H. 9 1-'68 Rev. 5M V 5>1/ 1::� s <br />