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FOR OFFICE USE: ,ti� <br /> 7 APPLICATION FOR SANITATION PERMIT p <br /> '� Permit <br /> .. . . ... . ... ........... <br /> (Complete In Triplicate) , <br /> a <br />•---.._....................._.._._......_....._........._ This Permit Expires 1 Year From Date Issued <br /> 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..,7 -3 .... .. ...................................................... ...CENSUS TRACT <br /> Owner's NameP.... .......................... .......... ..............:..:..................Phone .. . .. .... <br /> Address ............. .............755 trc .4 .w,v? _ ' y ... '�!"''.... •.............................................. <br /> Contractor's Name . .esr ,r.....License # ................... Phone ." 6 , �P..,7..... <br /> Installation will serve; Residence PTApartment House❑ Commercial OTrailer Court 0 <br /> Motel ❑Other ... �'`' o <br /> Number of living units:..../----- Number of bedrooms .,.......Garbage Grinder ............. Lot Size .' ............ ....................... <br /> Water Supply. Public System and name .---•---------•----•................................................_......................._..................Private <br /> Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam <br /> Hardpan ❑ Adobe Fill Material ............ If yes,type............................ <br /> IPlot 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 Ifpublicsewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK S�e.` Ci .. ......................... Liquid Depth S ............ <br /> ..I ; <br /> Capacity .12o..... Type ! -!- Material— <br /> No. Cornpartmeis .• .............. <br /> Distance to nearest: Well/029./Il........................Foundation --_�_0l..... Prop. ne .... 040. <br /> LEACHING LINE No. of Lines .....I...........:.... Length of each line-1AA��........... Total Lengtthh C �............. <br /> 'D' Box ....._ ..... Type Filter Material --Depth Filt Material ......49..r.......................... J. <br /> f�r .. <br /> Distance to nearest: Wei/619......:.......... Fo dation .................._.__.. Property Line __.___�___.._..,...._. <br /> • r/ <br /> SEEPAGE PIT ( Depth ....... Diameter ______ Number ____..._._/ Rack Filled Yes No f� <br /> �--- .............:r <br /> / �/ rr <br /> Water Table Depth...__... .+. ... .... -!--------------Rock Size .... .�:.�.��..--•.•• <br /> Distance to nearest: Well .__...... ........Foundation /..t :G .. Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date <br /> SepticTank (Specify Requirements) -------------------- ._........................................................................................ --------................. <br /> Disposal f=ield (Specify Requirements) .................... <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 bscoraksubject to kmon's Compenn laws of California." <br /> Signe __.r._ ...... E �' wa._�_ - ..a __. �KC._ Owner <br /> By -------------------------------------------•--_------------ - -- title . 1 <br /> (If other than owner) - <br /> FO DEPARTMEN ASE ONLY <br /> APPLICATION ACCEPTED BY ... ......... . . DATE ../ .�. .:.7� .-- <br /> BUILDING PERMIT ISSUED ................. _...__. .._..... ............DATE ........................................... <br /> ADDITIONAL COMMENTS -----._.! ..� .� . ✓.................... <br /> � <br /> .. J , ... .............• -••------. ...................................... <br /> ...---------•......................................... ...... •--•- •----........_... ................................................................................... <br /> .................................._....---------•- <br /> - ---------------------- •----- ..............-.............__. <br /> ....... ... <br /> Final Inspection by: .._.._..__..__-_�"� - ..--- _ 7 ...._...... <br /> ... .... ...........................Date .-... <br /> SAN JOAQUIN L CAL HEALTH DISTRICT <br /> 13 2 4 -1_.Aa .o-- cAA. -— <br />