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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> - - p <br /> p (Complete in Triplicate) Permit No. .7o- 5 ` <br /> ..._-_ <br /> This Permit Expires 1 Year From Date Issued Date Issued 'p-6- .76. _. <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 Regulations: <br /> r7� A) . Sy(.r6E-EAL/�- f / /' r <br /> J BADDRESSAOCAMON _/.�i .r_.. s.,_/YR......(2.C. .Q.....SL...----.1�-y._....:.........CENSUSTRACT ..L.a3-Z� dy <br /> Owner's Name ... "'-U j. (.r!+. _...-----.................. ..... - - ------ --------.. Phone ..--------------------..._..-------- <br /> yy L' c ' <br /> Address ........ --_-- --- 4-1------ e...(—__b.L�Q'4__....__..........Ci � �`/ <br /> �- city ...-----._.. ....--...._.....-- - - -- <br /> Contractor's Name ---- ....... .. ..v.�h,v---------------.--------------•----------License #Av r� :0"A' Phone .._�6 <br /> Installation will serve: Residencepartment House f:] Commercial []Trailer Court 0 <br /> Motel ❑Other <br /> Number of living units:... ._..... Number of bedrooms --- -&--Garbage Grind rX.G�f... Lot Size a <br /> Water Supply: Public System and name ------ .--- .............................. ----------------_-- _...............-Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑� )Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan El Adobe Fill Material .rlf/)If yes,type............................ <br /> (plot plan, showing size of lot, location of system in elation to wells, buildings, etc. must be placed on reverse side.( <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available with'n 400 feet,) <br /> PACKAGE TREATMENT [ ] SEPT)ICTANK ..............._ Ligyid 6epth __. .._..... <br /> Capacity/._? Typg� 5 Moterial.&.0�9......._.��No. Comp riments i..... <br /> Distance to nearest: Well ..._._I___....._..__.__._Foundat'on(//..�_.,i._......._ op. Line ..:5...1.=.,...... <br /> LEACHING LINE No. of Lines ..s�—................ Len th of each line._��+1 d' // g� <br /> Length .5 . . Total Le.gih f-I - - - <br /> // �✓✓JJ� �I r <br /> D` Box eSType Filter M��aat�tejjrial .1&0.'�6epth Filter Material _. !(�......___................_._. <br /> • Distance o nearest: Well __e��..�.._..... Foundation Prope <br /> / rtye Lina d�..�............ <br /> / <br /> SEEPAGE PIT [r� Depth .� ----_---- Diameter.3-........ Number °_.----- ........ Rock FillI�ry <br /> �d Yes o ❑ <br /> Water Table Depth ... ..............J__..--•--------.Rock Size . ./.�?:_':-�......__.,`�x./n�L-`�-•,/ <br /> Distance to nearest: Well .----40._....___x...........Foundation Prop. Line . ......-----:.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ......................._.-.-------:....... Date .............. ................... <br /> Septic Tank (Specify Requirements) ...---------------................... ............. <br /> Disposal Field (Specify Requirements) ------------- -----------'--•-- .. ................------....... .._------....... ............. -1 --------------­ <br /> (j <br /> ......................._.....,... - ....• ._......--------------------------------------------.................---------------------------------•----------------------------.... <br /> : <br /> - -- --------- ---------- -------------- ---------- .......................... -------.. . --.--••-•.....__......................-. <br /> (Draw existing and required addition on reverse side) <br /> I hereby codify that I have prepared this application and that the work will be one In- accordance with San Joaquin <br /> County Ordinances, Stafa Laws, and;Rules and Regulations of the San Joaquin Local Health District. Home owner or 11cen- <br /> sed agents signature certifies the'follotving: 0 ) <br /> "I certify that in the performance of the work for w1lch this permit is issued,,I shall not employ any person In such manner <br /> as to become subject to Workman's Compen laws of California." <br /> Signed ----------- --------. - - - - Owher . <br /> By .......----- ---, -- -- - --'- - .r�----------------------------------- <br /> oth an owner - .... Title . . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPtED BY... o _..._........_--...-...... DATE ... - .... .--.---••.--._.•.-------- <br /> BUtLDING PERMIT ISSUED .--: ..._.!_..., - - - <br /> ADDITIONAL COMMENTS ------------ . . - ---------------------------------- -- .....-- - <br /> --- <br /> - - -------- - ...... 7g........ — f <br /> t - - - -\� <br /> -----• t,--- Qf- <br /> ..---------'----- --------'-'-'�-- -- ---- - . ._..... ----- <br /> Final -------...................--------------------------- - -----......._Date ....Q,=t�'-�(3.................. <br /> SAN JOAQUIry LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'66 Rev. 5M <br />