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FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT 3 <br /> ......�.i. h .......I.... Permit No. ...-7 s <br /> O (Compfe»In Triplicate) <br /> ................. This Permit Expires I Year From Datelssued Date Issued . '� ....... <br /> 77 <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> ' described. This application is /ma/de In compliance with County Ordinance No. 5549 and existing Rules and Regulotiorts, <br /> JOB ADDRESSACCATTIION ...1.•f•• -... r... s ... CENSUS TRACT ........... <br /> Owner's Name .......; Z!�r s..... .........................................� ................ ........... . <br /> Address ......a$.'a/......5....l... � City f/ ...... .... <br /> ..................................... ................ ..... <br /> Controctor's --------License tP 37OS(Q41;r. Phone <br /> ' Installation will serve: Residence Apartment Housed] Commercial [DTrailer Court 0 <br /> MotelQ Other..............................._..... ..... <br /> g .'�. _Gorboge Grinder ..� c+ Lot Size .-_.��_0.4— <br /> Number of living unitse............ Number of bedrooms . <br /> ' Water Supply. Public System and name ..... ---............................ .................._...................................._.............Private <br /> Character of soil too depth of 3 feet: Sand 1D Silt o Cloy [] Peat[ 3 Sondy Loam ;r Clay Loom Q <br /> Hardpan Adobe (D Fill Material ..... If yes,type _.......................... <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be placed on reverse side. <br /> NEW INSTALLATIONr (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK( I Size................................................ Liquid Depth .......................... <br /> Capacity .�a�e�.. Type P '7 MaterlalC6.4+&L�N'o. Compartments .�.... <br /> Distance to nearest: 'well .{..... ... Foundation ...................... Prop. Line ..............._..... <br /> LE G LINE ( j No. of Lines ...........9)(Y� L W i d 1 ne..... . ...... Total Length ` ............. <br /> D' Box 11 .... Type Filter Material .,�..s.........Depth Filter Material ......�.1�...�....... ...._. <br /> Distance to nearest, Well ......ate .......... Foundation ....,�Q.�....._. Properly Line .r I <br /> SEEPAGE PIT ( l Depth .................... Diameter ................ Number ............................ Rock Filled Yes Q NWater Table Depth ....................................»..........Rack Size ................................Distance to nearest: Well ...................................._»Foundation .................... ProLine ........._....REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Dale ......................._.........Septic Tank (Specify Requirements) ..................O..... .____ ......._........................Disposal Field (Specify Requirementsl ...........e.......x..�............... ............. .............�-�_.................._............. ................................ _ <br /> eft l/fD / <br /> ...............................................DL<� -.V L6... <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 accordant* with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Homo owner or lino- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit la issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ,.............y�t/. . _... Owner <br /> By ...-- &,&-. .................................... T{tle ....._..................................................._........... <br /> ilf other than owner) '51 J <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . ........... .. .. r- ........... ...................................-................ DATE.... ................ <br /> BUILDINGPERMIT ISSUED................................................. .............._.......................................DATE ........................................... <br /> ADDITIONALCOMMENTS................................................ ............................................................................................................ <br /> .........-•-------•........................................................................._.............................................................................................. <br /> ................................................ .. ..................... ...................................................._............................................................ <br /> ..................................... ... ... ................. <br /> .._..._........ ._....... <br /> 7. <br /> Final Inspection bye ...... .... .. ....... .. .. .. . .............................................................Date. .:1...".. . ............. <br /> SAN JO UIN LOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M 7/72 3 M <br />