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FOR OFFICE USE: APPLICATION. FOR SANITATION PERMIT <br /> Permit No. 7 � <br /> (Complete in Triplicate) <br /> ---- --------- -----•-•------- <br /> Date Issued ---6.`1r73 <br /> .._. <br /> ------------------------------- This Permit Expires 1 Year From 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 Regulations: <br /> JOB ADDRESS/LOCAT ON ------�J.054—_---E_.._-_/�-��---fs�� CENSUS TRACT �----Z_ <br /> Owner's Name Y-_C_�./ ------- � Pho`ne/ <br /> Address -------------77OS-Z-------1. ----- -!�wx-----/�LQ---------- City -----4C- ��V <br /> Contractor's Name ----Q-V_V F-(Z----------------------------------•--------------------:;.-.License # ------------------------ Phone ------------------•----------- <br /> Installation will serve: Residence)<Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ---- --------- ---------------------------- <br /> Number of living units:---- --__.-. Number of bedrooms Garbage Grinder/.�S_ Lot Size _. 9 EAG ------- <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 J?J' Adobe E] Fill Material - _...f/_._ If yes,type ----------------____________ �J <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep 1,165 pit permitted if <br /> !public sewer is available within 200 feet,) cr <br /> ,( �z-- --�- Liquid Depth r <br /> PACKAGE TREATMENT - [ ] SEPTIC TANK t Size__'_ _____ _______ <br /> Capacity �JZ�v.._ Type r4VRE�b Material_C0M_FkTR_o. Compartments ------Z.--__•--. A <br /> Distance to nearest: Well -------.�--'t—------Foundation ----/Q....�.-Prop. Line ...................... 'r <br /> t .-_-- Total LengthJ LEACHING LINE No. of Lines _....--_�.__.-._--. Length of each line.---75. _--._..'D' Box SType Filter Material 0_C&Depth FilterMaterial -_---_�7__11____________ ....._... <br /> DD --� <br /> Distance to nearest. Well _--- ------ Foundation ..� _. ____ Property Line __ ______________ <br /> r - <br /> SEEPAGE PIT11' Depth --. y._____ Diameter l�.1_Y- - Number ....... Rock Fill d des �o <br /> Water Table Depth ----_ s �__' '___ Rock Size ,lL_-_-.22r <br /> Distance to nearest: Well ----- 7t!...........Foundation --t_________________ Prop: Line ..�A---•-:.._______ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------� Date ----------------------------------) <br /> SepticTank (Specify Requirements) ---------------------------------•--------------------------------------------•------------•-----------------•-------•----------- ....... <br /> DisposalField (Specify Requirements) ------------------------------- ----------------------------------------------------------------------------------------------------- <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 San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify tcf in the perform nce of the work for hich this permit is issued, I shall not employ any person in such manner <br /> as to beco subject to Wor n s o pensati laws of California. <br /> Signed �,�/Y>_ CLC -- --- Owner <br /> BY -------------------------------------------------------- --h-R-7i Title --- _----------------------- ----------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------7--!-[1-'-01----------------------------------------------------------------------- DATE ----- 1 J - ------- <br /> BUILDINGPERMIT ISSUED ---------- --------------------- -------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -- --- - <br /> -----------------------------------------------------------------------------------------------------­--------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------VV. t------------ _ - ----------------------- <br /> --------------------------------- <br /> ---------------- <br /> ------- ---- ----- <br /> Final Inspection by: 1 - _...................................... <br /> ----------- -------•--- ---Date <br /> •z - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M C <br />