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II <br /> POP-OFFICE USE: APPLICATION FOR SANITATION PERMIT _ <br /> ------------ ---------------•------- ------- Permit Na: -`�_� __3_0 <br /> II (Complete in Triplicate) <br /> ------- ----- <br /> (-S Date Issued �._-_�Z�_7. Z <br /> -----------l` This Permit Expires 1 Year From Date Issue' <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/LOCATION . � ----- CENSUS TRACT <br /> r— <br /> • -�s2P -0'eV_ #o <br /> ne Owner's Name ------- -= _a ---- <br /> --------------- <br /> Address <br /> ----- - A �� - `? I //� CitYn /i --Phone 7 ----------------- <br /> Contractor's / <br /> l �; <br /> Name .- I( /;- ---" <br /> ------------------Lice se <br /> Installation will serve: Residence House❑ Commercial ❑Trailer Court11 <br /> Mote�Vpartment <br /> ❑Other -------------------------------------- ---- <br /> Number of liven units:--_ -. i--.- Number <br /> g of-bedrooms __ ^--Garbage Grinder 7 <br /> 6./ ' Lot Size --------------------------------------------- <br /> Water Supply. Public System and name(j_._,� _ y ) l ----Private <br /> Character of soil to a depth of 3 feet: S p'd'❑ Silt[:1 Clay ❑ Peat❑ Sand y,,Loam -E] Clay Loam ❑ <br /> OW <br /> Hardpan E] Adobe l Fill Material --;�f_(, If�yes, type --- ------------------- <br /> (Plot plan, showing size ofl lot, location �o f system in ,relation to!we_Ils-b—,a] ngs, fetc. must be placed on reverse side.) 1�y <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ I SEPTIC TANK [ Size-------- __/.. _ -- ------------ Liquid Depth --- I <br /> {--�� !r�7y__� Material_[�-,F f•-� artments -_-f _..___ <br /> Cana city _,Ar I-- Type No. Comp <br /> Distance to nearest:kWell ---------- -----------Foundation -- _'"-- --- Prop. Line .` ------------- <br /> LEACHING LINE [ No.1 of Lines ------ _ ------ Length of each line..11_1.4r--- Total Length ,//e%------•-__._--- <br /> D' Box A4,,.�_ Type Filter Mate_ r al :_ _�?�•___ --Depth Filter Material -_--��_-_-__--------------.----.--•-- <br /> -. <br /> Distance o nearest: Well ------ --------r__-- Foundation .---- �c _ r -+�► Property Line _f15 <br /> it � J � '�► �- <br /> SEEPAGE PIT [ Depth - -- ---------- Diameter _- = _- -_ Number --..---�_--- -- -_ Rock Filled Yes [ No ,i❑ <br /> t9 � <br /> Water Table Depth _f�--r___I±_ Rock Size ---___/ ------ <br /> --------...Foundation -- ---- ? Prop. Line --_------------- <br /> I <br /> Distance to nearest: Well -------------* ____-:._ - <br /> _ ._. r. .. <br /> R AIR/ADDITION(Prev. Sanitation PerP # -------- ----- ---------------------- Date ----------------------------------- <br /> s) <br /> -----__---- --- -.--------------) <br /> i <br /> I ------ <br /> /Septic Tank (Specify Requ'rements} �------- --------------------------------------------------------------------------- ----- <br /> Disposal Field (Specify Requirements) -------------------------•----------------------------------------- --------- -------------------------------------------------------- <br /> ----- -- ----------------------%-----------------------------%-------------------------------------------- --------------------------------- <br /> ------------------------------------------------------ <br /> ------ ----------- ------ -- -------- :--------- --------------- <br /> ------------ -------- <br /> �M -------.-----�---- -- ----------=--------------------------------- _ ----------------------- <br /> V „ �' (Drrow existing and required addition on reverse side] --, <br /> I hereby certify that 1 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 n t employ dny person in such manner �. <br /> as to become subject to Workman's Co Mpensdtiort`laws of California." <br /> Signed -- ------ ------ ----------------- ---------------------------------i----------------------- Owner i <br /> - Title _ '�'�' -- /( <br /> ------------ <br /> E_- ----------------------- <br /> (If other than o e'r)� - <br /> 11 OR i EPARTMENT USE ONLY <br /> 'APPLICATION ACCEPTED BY - = _ _" - DATE y <br /> --- --------- -------- t-----. - <br /> BUI'LDING PERMIT ISSUED !� - - - - - -------- --- ------ DATE <br /> DITIONALCOMMS T _JL---- --- - -- --=-------- --- - -------------------------._-_ --------------------------- - --------------------------- <br /> --------------------- <br /> - ' <br /> ------------- <br /> - - - j -- 1*------- ---- ---------------------- <br /> ' I ---------------------------------------- ------------------------------------- p <br /> ! '^ "------------------------------------ ---�._'-- <br /> ----------------------------------- <br /> Final Inspection by: ---- - --�I -- ---- - - ----------------------- ------- --------------------------Date -------� <br /> --- - -------- <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 ev 5l %,N411\ <br />