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APPLICATION FOR SANITATION PERMIT X <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />r construct and install the work herein <br />Application is hereby made to the San Joaquin Local Health District for a pemit to <br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />CENSUS TRACT <br />Phone - g <br />aZ122.kv... <br />City <br />cense - 7 7) Phone .h 3 2— 19 0 <br />Residence jtkartment House0 Co ercial '0Trailer Court fl ^ <br />Private fig <br />Motel 0 Other <br />Number of living units. / Number of bedrOoms a .Garbage Grinder Lot Size <br />Water Supply: Supply: Public System and name <br />Character of soil to a depth of 3 feet: Sand 1J Silt 0 Clay• D :ePeat <br /> <br />4- Hardpan 0' Adobe-0- Fill Material <br />ernpl oy any person In such manner <br />(Plot plan, showing size of lot, location of syltem in relation to wells, buildings, etc. must be placed on reverse side.) <br />'..i.' <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if iDublic sewer is available within 200 feet) <br />PACKAGE TREATMENT [ 1 SEPTIC TANKI ] . Size . ..:-...,. . ....... . Liu id .Depth , <br />Capacity ./3..a.0::-.e.4Type Material No. < Compartments ---,. <br />Distance to nearest: Well MD- Foundation /65 Prop. Line ,A16( <br />LEACHING UNE [ ]ne No. ,of Lines' ' V._ Length of each line . EP- Total Length /.,4 6 i <br />"sAt tsq.,_ 'D' Box ifea. Type Filter Material .gp..:Rer--:, Depth Filter Material /i5"7 <br />Properly tine, c9C61' <br />SEEPAGE PIT Depth Diameter Number <br />Water Table Depth Rock Size <br />Distance to nearest: Well Foundation Prop. Line <br />REPAIR/ADDITION (Prey. Sanitation Permit* Date 1 <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner <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 <br />as to become subject to Workman's Compensation laws of California." <br />Signed Owner <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />Final Inspection by: <br />E. H. 9 1-'68 Rev. 5M <br />DATE <br />DATE <br />FOR DEPARTMENT USE ONLY <br /> ..---- r"---;,.=,' .. 4111•Y , .,. , 0 <br />SAN JOAQUIN LOC <br />Date <br />EALTH D S ICT Roc .ge <br />40. - • o. <br />..T.OrOFFICE USE: <br />- <br />Permit No: (7 7 )1 <br />Date raard .7.-2 <br />1. - <br />JOB ADDRESS/LOCATION 7.9 3 pcii.A. 6.42-t <br />Owner's Name <br />Address <br />Contractor's Name . <br />Installation will serve: <br />4 <br />'Sandy Loam 0 Cloy Loam 0 <br />—if ye; type <br />- ' "".§b.'"i'aionDistancetbnediestiWell 1 FoCid <br /> Rock Filled YesO No <br />(D-raw existing and required addition on reverse side) Joaquin <br />or licen- <br /> Title <br />(If other than owner