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<br />: FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br /> <br />This Permit Expires 1 Year From Date Issued <br /> <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 />fj---6 • 4/, <br />— JOB ADDRESS/LOCATION .("44 /14. <br />Owner's Name . . <br />fl <br />Permit No. <br />Dote issued <br />Z-45 kl--,02-0 2- <br />Address /6 koo S, Car:7 -4474" <br />Contractor's <br />Installation will serve: Residence PrApartment House Fi Commercial DTrailer Court <br />Motel Other <br />Number of living units: / Number of bedrooms g Garbage Grinder Lot Size A c.t3 E-A 6E- <br />Water Supply: Public System and name Private <br />Character of soil to a depth of 3 feet: Sand [7] Silt 1:1 Clay Peat fi Sandy Loam /Cloy Loam <br />Hardpan ri Adobe LI Fill Material KO If yes, type <br />OF-) La _44-"e CENSUS TRACT 6 <br />(s17-zy - A'n--1//4 /1/ phonegA3-6-3-51/ <br />City ,,,47/9,4/.74-C,9 _ <br />74 License # -2-Co2.3$70 Phone <br />I other than owner <br /> <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />Distance to nearest: Well <br />LEACHING LINE ki No. of Lines Length of each line Agb-' Q. Total Length ....-, .. .. tg° <br />'D' Box I Type Filter MaterialA k Depth Filter Material M " <br />Distance to nearest; Well S-'0 Foundation 10 Property Line ..5— <br />SEEPAGE PIT [ 1 Depth ... Diameter Numbe- .... Rock Filled Yes 0 No 0 <br />Water Table Depth Rock Size <br />Distance to nearest: Well Foundation Prop. Line <br />REPAIR/ADDITION {Prev. Sanitation Permit # Date ) <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) N3,3,00._ <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 that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to become subie to Workman's Compen i...2ws of California." <br />Signed Owner <br />/t) <br />FOR DEPARTMENT USE ONLY <br />BUILDING p.tpon- ISSUED <br /> DATE - 2- - APPLICATION ACCEPTED Br; 11.K 1: <br />. ADDITIONAL t OMMENTS <br />Final Inspection by: <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />NEW INSTALLATION: (No septic tank or s7ge pit permitted if public sewer is available <br />PACKAGE TREATMENT [1 SEPTIC TANK Size <br />Capacity '100 0 Type Material 014-6- No. <br />Foundation <br />within 200 feet,) <br />Liquid Depth 6/1/ <br />Cornpartments <br />,-/ <br />Prop. Line Qo <br />By ...... :Title . <br /> DATE <br />E. H. 9 <br />r 1 <br />1-'68 Rev. 5M