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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION fOR SANITATION PERMIIT <br /> ----------••----•-------- ........._ ........ <br /> Permit No..-7�-�--'S.� y <br /> r (Complete in Triplicate <br /> - Date issued-_ 2 9 <br /> ......................... .............__...........-_.- This Permit Expires ] Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District fora permit.to construct,and,install the work herein described. <br /> This application is made.in compliance with County Ordinance No. 5�t9'and existing Rules and Regulations: \, <br /> JOB ADDRESS/LOCATION...._- /-.�.� -- � ----------------- --- ---•--,CENSUS TRACT------•-----=----- --- ------ <br /> • ---------� • - ---....- --Phone....:-------- <br /> Owner's <br /> -- ---Owner's Name...... --- _-- _ --------•• l <br /> Address..--- - City..........- Phone � `4 �• <br /> --- <br /> ip .. <br /> Contractor's Name. �- .:..... .License #.��F� O"�// .. <br /> Installation will serve: Residence Apartment House ElCommercial ❑ Trailer Court ❑ <br /> Mo el F1Other__.. ....... ... -- ---------- --------- <br /> Number of bedrooms-:7:,___3 bGi <br /> Garage- rnde{___.r.--L-ot-Size.......... .... <br /> Number of living units:.-..-..1..-_ 1 <br /> e .itAILC /�.../�CJ�P . . --.Private <br /> Water Su ly: Public System and name.. ..i�j(1�l-QJi-���c ��~+I �' --,i�.a. <br />; v <br /> Character of soil to a depth of 3 feet: Sand E) Si ElClay El Peat ❑ Sandy Loam ElClay Loam ; <br /> Hardpan ❑ Adobe 0 Fill Material.. ... _.Af yes, type----------- --- <br /> (Plat 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 seepage pit permitted if public sewer is available within 200 feet,l <br /> /�� •y ------- Liquid Depth... <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size .....�1 ../`� -• , <br /> Capacity. ..._ ..Material-. ?�..-•------.-No. Compartments..-.�-1 ... ----�1 <br /> p Y ` ..Type. - <br /> Distance to nearest: Well---- .. ---.. • - . <br /> Foundation.-......L 0-....._...Prop. Line--- ---------------- 0 <br /> �._:_- -- Total Len t <br /> LEACHING LINE [ ]' No. .of Lines .-.-- --- <br /> Length of each line .--- ' -- g .l..... <br /> 1 - Depth Filter Material....- /.-.�-- -------------- ------- -- -- --- - <br /> 'D' Box_ ....1.....Type Filter Material......_...- p <br /> I 1 �� <br /> • I ...Property Line_--•--...--`-=- -------- ------ <br /> -- <br /> Distance,to nearest: Well t......_.-----.Foundation_---... ..---•--------- p Y <br /> , Rock Filled Yes No <br /> EPAGE,PIT { ] <br /> Depth...... <br /> Diameter. Nu.mber... ' 1 <br /> t <br /> Water Table Depth..- .=--- .. >.. -` "' Rock Size-_­ <br /> Water . <br /> t. <br /> i ( t <br /> Distance to nearest: Well-------------- --- --------`" -Foundation--.- ----------... --.._Prop. Line----- ------ - ----- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------- :=- -- ...... . D;ateF:..-----•-------- 1 <br /> Septic Tank (Specify Requirements)------ --------- ------- --.... <br /> -- ----------- <br /> ` �T-7 <br /> Disposal Field (Specify Requirements)........---------•.-;_ -•- ---'---------------- ---- ... -�---- - <br /> ..--- ............. ---------------------...._.... --, ...... 4 ........-------------------..--....__--- -----------.... ...... -..- <br /> l <br /> (Draw existing and requiied addition on reverse si e <br /> I hereby certify that I have prepared this application and that the work,will -be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Wealth District, Nome owner or licensed agents <br /> signature certifies the following- t <br /> "I certify that in the performance of the work for which this permit is issued,rl shall not employ any parson in such manner as <br /> to become subject to Workman's Compensation laws of California." " <br /> Signed..-.. ..�-........ Owner,. �A <br /> (I ther than owner) <br /> F R DEP RT ENT.USE ONLY .4 <br /> APPLICATION ACCEPTED BY �. ........... DATE <br /> -- F -'= <br /> f DIVISION OF LAND NUMBER.-... - - . . y DATE.- _.. _. <br /> ADDITIONAL COMMENTS.. ../ ..�fBh *1r,/' /t iVt <br /> v.Ae� Q' <br /> ---------------- - <br /> ---- ------------- ------------ ---Wit` ,..r i ._c,ax.� . fes- ..-... . <br /> OM e;r <br /> o/ <br /> _.-... - ---Date...�D <br /> nanspion '....:. <br /> Final Inspection b ----- - <br /> 1 F&5 21677 RW 3M <br /> 1, e►+ 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />