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i <br /> FOk v)trFiCE USE. APPLICATION FOR SANITATION PERMI'C <br /> Permit No: ..�:�...`3�"f <br /> (Complete in Triplicate) " <br /> ................... ................................... S �1 `.. <br /> Date Issued ......_�.._........ - <br /> This Permit Expires 1 Year From 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 wish•County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS-/LOCATION .-.::: � :...� 1 "UE. --......................................CE ACT ............._.... ....... <br /> CENSUS TR `....� <br /> r, . .: :,.. �, p <br /> Owner's Name .... _ .�= �-- !7.......... ,....... Phone .................................... <br /> }= <br /> Address -� ..............._----• ---.... `....---....... ...... ... <br /> ...-• ------- ~�----- `.'. ............. City_ - - A� <br /> 0-W710 t:..........' _....License # _...-r— _..,. ... Phone .............. <br /> Contractor's Name .... =-..- .........�_ . <br /> Installation will serve.- "";- —Residence ❑Apartment-House0 Commercial ❑Trailer Court C) <br /> 4 her ....../..........�.... .. ... ........ <br /> Number of living unitTsi _� Numberofbedrooms 1...... Garbage Grinder .__......_-- Lot Size i............................................ <br /> Water Supply: and name --- . . -----.... --••-•---•--Private-(] --- <br /> r r =� =� <br />_ _ <br />! Character'of soil to a depth of 3 feet: r Sand El `Silt ] C (x '� ` Peat'[} Sandy Loam [] { Clay Loam ❑ <br /> Hardpan ❑ Aube' Fill Material i,.__..---..t if yes,type ...:---...-------•-....._--- <br /> {plot plan, showing size of lot, location of system 'in relatio"K to wells. buildings; etc. must be placed on reverse side.] <br /> k NEW INSTALLATION: �,(No septic'tank or seepage_pit permitted if�Sub�ic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT:i%j } SEPTIC TANK Size__...... ... .__..... --- Liquid Depth .......:..:............... <br /> ,Capacity yp �.. o. Compartments ...:...............:.. <br /> -_Distance to neares : Well ....................................Foundation .._ ............',-,Prop. Line 1 <br /> LEACHING LINE j ] �No. of Lines _-__. ...1........ Length of each line....--..------- Total �engfh ...:_•...................... <br /> " "'D"Box __-- Ty a Filter:Material Depth Filter.M terial ................•.. ....... <br /> j � <br /> 4 Distance to neares : Well ......................... Foundation ................. ...... Property Line <br /> i <br /> SEEPAGE PIT Depth Diameter Number ............................ Rock-,Filled Yes ❑ No <br /> j i p ..... <br /> + <br /> A, Water Table De ................:..Rock Size ........ <br /> 5 G <br /> � '•---•--...------. F -• ---.._._.-rProp. Line -7J� P <br /> }* ": Distance to:neares ell .,....................Foundation _.__ .....---_--- j._ l <br /> REPAIR%ADDITION{Preva Sanitation Permit .........................••• Date ._....._......----.--........... ]' <br /> Septic Tank (Specify Requirements) ............ �Jp� .� �.C " ..... <br /> F <br /> :1CH� :n► -:..�=. i <br /> �r . �X!� �[Ir�DispoiaRequire,l Field (S ecify ments) <br /> TRS-� 11G: — <br /> ..-........mpl'.Rax........d..._ .._ _....- . --- ............. ; <br /> (Draw existing and required addition;on reverse side) �.-� --- <br /> I hereby certify char 17save lirepared this application and that the work will be done in accordance with San Joaquin <br /> County 'Ordinan'ces, 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 at lri the perFormance of the wo'k for which this permit is issued, I shall not employ any person ie such manner <br /> as to be e s ]ect to^ kman's'Co Jof`Califorinia:"� 7h <br /> Signed . .. ..... ...: ....'.L_"_. . ._. ... ... ------4..:.....:...... . Owner <br /> • <br /> Title <br /> l (If-o_&r than owner) <br /> k FOR DEPARTMENT USE ONLY <br /> • Jrf' � �,.,5 <br /> APPLICATION ACCEPTED BY T -.O...........:.......................... .......................... DATE ...................... . <br /> ,. BUILDING PERMIT ISSUED DATE <br /> ADDITIONAL-COMMENTS .-.= -_--.--,_.—.: --r• ,= ..:.::..: <br /> .. ............................ . X14.-N � ••__.:5....-.1_.../ ,• . _.�_ ............... ............................ <br /> ..._.�_._._... .�.�fl.l. '/ if 't...Aw% _ _�-�.�u /, 1 Vii..................R.-...... -- i+ r."."..__ -G�` ...�... --�`�._-'.,..•.T - <br /> Final Inspection ... _ � ...w .. �! �f�� Date .....1.....�� ~.7�•-•-•••.•-•• <br /> SAN"JOAQUIN LOCAL HEALTH DISTRICT <br /> r_ 14_ 13 241.'68 Rev. 5M. _ 7/72 3-M <br />