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FOR OFFICE USE: APPLICATION,FOR SANITATION PERMIT <br /> Permit No. 7,�?-:.3.a_-�- <br /> (Complettrin Triplicate) <br /> :.1 Y <br /> • z3 7v <br /> __ This Permit Expires 1 Year From Dote Issued 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 Jmade in compliance with County Ordinance No. 5449 and existing Rules and Regulations: <br /> JOB ADDRESS/LaCATIQN !..I. nn.�� nn --r..�-!.. _�. �1.Y__1 -- C.i- ---------CEN5U5 TRACT -----------------•-------- <br /> Owner's Name _... .-�.:._'. 1.x.1AZE —___�_A �I�..___-• • ���.............. Phone-.c7_3- 1_.�U_r.�-.�r..7 <br /> Address -----U..�4. .. .__ _..._1�1.�—.p_�. tC _.City _S-iCCA 7-f AI......._-G-T--4-i.............-.---r--- <br /> Contractor's Name ._.License # 1 Qa5!-�__-- Phone4..�?�,3_�_�-_�L.. <br /> Installation will serve: Residence gApattment House❑ Commercial []Trailer Court C] <br /> Motel ❑Other.-..--•-•-----------------------------... <br /> Number of living units:._ __ Number of bedrooms ....Q...._Garbage Grinder ------------ Lot Size ..�}. '., ! ..._-..... <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 ❑ Adobe ❑ Fill Material ------ ----- If yes,type -,---•---------------------- <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 tonlf or seepage pit permitted if public sewer is ci vailable within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size_......-...................................... Liquid Depth ..__--------..._....--.-.- O <br /> Capacity ____________________ Type -----------------.__ Material._.... No. Compartments _:.—.-._--_•-----_. <br /> Distance to nearest: Well ------------------------------------Foundation ---------------- Prop. Line ...................... <br /> ----- Length of each line............ --------------- Total Length ...--------_-- ---.•__---- <br /> LEACHING LINE [ ] No. of Lines ---------.--__-_-- g g - - <br /> 'D' Box ........... Type Filter Material --------------------Depth Filter Material ------------------------------------------- <br /> Distance to nearest; Well ------------------------ Foundation -------- Property Line -----•----•-•----------- <br /> SEEPAGE PIT Depth ------------_------- Diameter ------- Number ---------------- . Rock Filled Yes ❑ No 0 <br /> Water To* Depth ........ ........ 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) ..A.D-p_�_-TVAIAL. �..-a�..-Q-___..L A UN•-.---•-.-�---- <br /> ----------------------------------------------------- ......................---------------------- __.�w:..-..............._ - - - - T----p__............ -------- <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 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 beep sv iect to Wor frer an's orsiation laws of California." <br /> " <br /> Sign ------ owner <br /> -- ['t LAC t <br /> (If other than owner) <br /> 14- PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ----• ....................................................... DATE---Jam.-=..iz., <br /> BUILDING PERMIT ISSUED --------- - -- ------ - -- DATE ..............----------------------------- <br /> ADDITIONAL COMMENTS - - - - - - ._- -- -----•------------•--------- <br /> 11A.....�.� ------------------- -__� -==- --� - ----------------------------------------------- --------------------- <br /> ------------------------- :........r:/--------------------=--------------- 7 <br /> . <br /> Final Inspection by: -- ,cf1 _Date_________ _____'... ................. ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />