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FOR OFFICE Ess •d: . <br /> v — APPLICATION FOR SANITATION 1twRMIT <br /> �- <br /> ,. {Complete in Triplicate) � Permit No74..n_.......... <br /> .. <br /> ' ........ I ThIs Permit Expires I Year From Date Issued Date Issued`...�._......... <br /> t <br /> r 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 Regulationst <br /> JOB ADDRESS/LOCATION .._..._...1 lP; .- j/ r?_�"•.lr../,.. <br /> 2... G ..................................CENSUS TRACT <br /> Owner's Name ................... fk .....�" .7.C-�:.. ._ <br /> ............... <br /> Address ---------- x1 _ -- _ _ _ C :��:.. _.�.._ ..Phone_ .., ,.� :............. <br /> ................ <br /> ... <br /> 1i <br /> �_ .f.. <br /> Contractor's Name , <br /> - -----••••-- -,..._ -cense #�--7-,1.��� Phone <br /> Installation will serve: Residence❑Apartment House.o Commercial OTraller Court. 0- <br /> Motel E]Other --------------------- <br /> ................ <br /> Number of living units_________ Number of be ams .a_._.-Garbe a Grinder Ll__e.�__-_ Lot Size <br /> Water Supply: Public System and nam o <br /> . ...F <br /> c .......... ` .........................--.1 _ Private❑ <br /> Character of soil to a depth of 3 feet: Sand t7 Silt❑ Clay t l] ._._.Sandy Loam fl Clay Loam ❑ <br /> Hardpan Adobe iii Material type '• <br /> .�lfl.. If yes, pe.............s. _...._.._•:_ <br /> (Plot plan, showing size of lot, location of system in 'relation to wells, :buildings, etc. must be,placed on reverse side.) <br /> F NEW INSTALLATION:_ (No septic tank or seepage-pit permitted If public sewer is available within 200 feet,J <br /> PACKAGE TREATMENT [ ] SEPTIC TANK <br /> ----� r w- *',�. Siz�e... /� ?l -Liquid: Depth <br /> ..... <br /> 4Ca <br /> Capacity --- -- Typa Material=_�r.�---ti � <br /> g <br /> ,. <br /> .... <br /> ...............�► <br /> pistance to nearest: Well -_-•_-- _ - <br /> ---------------Foundation .__ -v- --------. Prop. Line 4 J � <br /> LEACHING LINE [ No. of Lines I---•-------- • F -- <br /> Length of each fine---.--- _-_C7. _....._- Total tength �d-- <br /> t / r <br /> D' Box _,Nd.?_. Type Filter Material 'Y..�? =l--------Depth Filter Material ---( - --.-.- .f. _-•- -- <br /> t, . . ...... <br /> .... ... <br /> [ <br /> Distance to nearest: Well . ZI///t y,. Foundation ._- � r <br /> erty line <br /> --•-•--- Prop <br /> SEEPAGE PITDepth <br /> ..S ,....� <br /> De th .. . ............ Diameter .. ._j... Number ....... -----....---_--- Rock Filled: Yes Q . <br /> Water Table Depth ._------- •0. ...................Rock Size <br /> Distance to nearest: Well __-__. o - <br /> ,N _Foundation ._..-�-- --f....._. Prep. Line .......:... <br /> REPAIR/ADDITION(Prev. Sanitation`Permit# .........._.. _:_ _- - - ~, <br /> Date = ) <br /> Septic Tank (Specify Requirements') ............................1... <br /> Disposal Field {Specify Requirements) ._._______- - <br /> ------•-••------- --------------- <br /> ------------- ---------------­­­­-----------­--­--------- .......... <br /> ------------------------------------ <br /> raw existing and required addition on reverse side) k <br /> I hereby certify that 1 have prepared this application and th at the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licon- <br /> aed agents signature certifies the following: ; <br /> "1 certify that in the performance of the work for which this permit is Issued, I shall not kem Io <br /> as to become subject to Workman's Compensation laws of California." F y any person in such manner <br /> E Signed ' <br /> ---- - <br /> Title <br /> ---•�------ .. ._.__..- _ Owner <br /> y <br /> ••---••------------••--=----- <br /> (if other owner! f <br /> i <br /> i FOR DEPARTMENT USE 'ONLY <br /> APPLICATION ACCEPTED BY --- ........... ._. DATE ...I a.j. .�. ..._.._.. <br /> BUILDING PERMIT ISSUED ---------- -...... ... -•-•- -- ----------- <br /> --•---------•--•------- DATE - . <br /> ADDITIONAL COMMENTS ..............s__-_• - ----'----•------....-------- <br /> ------- 4 . <br /> ----- <br /> -- z <br /> ---- •------------- ............. <br /> v. / <br /> -••---- ...... ............... -----------••----•---------------� ----------- ---Date _.....--f��-7-'---�7�..:�--- <br /> Final Inspection by- ------------------ <br /> ER l3 2h 1-6� SAN OAQLlIN LOCAL HEALTH DISTINCT <br /> l + <br /> 3 <br />