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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ...................................... --------•-•...... Permit No. <br /> J <br /> lComplete In Triplicate) �_ <br /> ......................................................_ 2'r,.5..'. ` <br /> ......--•.................................... This Permit Expires 1 Year From Date Issued bate 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 Rulers and Regulations <br /> JOB ADDRESS/LOCATION ..................................................:...CENSUS TRACT .......................... <br /> Owner's Name ....-Tom FornaBera............................ ......--•---....•----_....-••............................_.Phone 83 ............ <br /> Address .......7-6a .-.W.....L!nnQ- Rai-:----------------------..-.._.._----I——........ City ..Trac-y.................................:.. ......---•............. <br /> Contractor's Name ----��Pay Les•!!__ ep C__Tank & -Sewer _. cerise # 2617-37.----.-- Phone $3.5..781 b6.....--... <br /> Installation will serve: Residence[X Apartment House❑ Commercial OT- railer Court ❑ t <br /> Mote[X]Other ------------=----•-••..............•----•••. <br /> Number of living units:-._ ------ Number of bedrooms ---?-. ...Garbage Grinder -_I?q.... Lot Size ......aCre...�B___. .......... <br /> Water Supply: Public System and name ------------ ........................•--.......--------•--------------- ................... ........Private <br /> Character of soil to a depth of 3 feet.. Sand Sil# _Sand Loam. -.;.Cla Loam- - - - -•_ <br /> p ❑:� ❑ Clay.)]. Peat.❑. .-- y. .0-;;;-Clay-y.- _]- . <br /> Hardpan [] Adobe lk fall Material ............ If yes,type ....I.......... ............ <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 tank or seepage pit p Brmitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK f J Size........................................... Liquid Depth ..-........................ <br /> J <br /> Capacity ---------- --------- Type ---•- -•---------. Material......... ----------- No Compartments ..................... <br /> Distance to nearest: Well ....... ............................Foundation ...--...-- ----------- Prop. Line .-- ----__:---- ---pC► <br /> LEACHING LINE [ I No. of Lines ------------------------ Le gth of each line..........._-_--............ atal Length ......... ................... <br /> D' Box Type Filter Ma ria) .Depth Filter Mate ial 0 � <br /> Distance to nearest: Well ........ .............. foundation ......-_.._........... . Property Line ...._......._._......... <br /> SEEPAGE PIT [ Depth -------------------- Diameter --- Number ----........__.-.-...... . Rock Filled Yes ❑ No <br /> Water Table Depth ---------------- -••----•-•-•••... ............Rock Size '.._.....- ----------------- <br /> M •--•-•--•-- 7 <br /> Distance to nearest: Well .... .. ...............................Foundation ....... . .......... Prop. Line .....-----:........--.N <br /> REPAIR/ADDITION Wrev. Sanitation Permit# ------._.-_. . ...............•-----__---- Date ................... ........ <br /> SepticTank (Specify Requirements) --------------•---..--.............................................................. ........................,---,..-------.._................. <br /> p Y 3t rox�mate 8 _#'t,..5--� <br /> Disposal Field (Specify Requirements) ...��� �'�l'tg_..f?�-_�,:�-i���?_•��n8-..oi'n3. ----�-l�.R�.-..-...---•----....-�.Y__...- <br /> L5pGN -----. ---------------- .................. <br /> L E� c H a nl L-S <br /> T <br /> � 17 5 - .�................................... <br /> (Draw existingand required addition on revers e) <br /> r 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 liten- <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 ecome subject to Workman Cernpensation ws of California <br /> ri <br /> Signed .. ...... ....... .... ..- -- -- ------ .. ......... Owner <br /> BY .. -------- -Title -------Contractor......... -- <br /> a o erl Pe y Warthan <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- -----•-----------------------------••------ -------------------------------- DATE - <br /> BUILDING PERMIT ISSUED ...... -----------------------------------------------------------..-----. -..------..-........... -------DATE ....------ .-..-------_---- ----- <br /> ADDITIONALCOMMENTS ------•--- -- ----------- ........................ -•...--•••-••---- -------•-------- --- _..-.-..-..---------------------------•-•---- ------------ <br /> ----- ----------- ------- <br /> Final Inspection -•...............................•- Date .-............-.-. ..-" <br /> Ik EH 13 2h 1-6$ : dev. ym SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M <br />