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FOR OFFICE USE: <br /> APPLICATIONmFOR S7NITATION PERMITpri <br />....................... ................................ plicate) Permit No. <br />--•••••••---••••-•---•••...........11................... This Permit Expires I Year from Date Issued <br /> Date Issued <br /> Application is hereby, made to the Son Joaquin Local Health District for a permit to construct and instoll 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 .......0-4.1- --------- ......­­­......... CENSUS TRACT ............. <br /> Owner's Name .........P_. <br /> ............ ................................................ <br /> -------Phone <br /> Address ...... C i t y <br /> Contractor's Name ....--•---•Cq -------------------------------------------License #o✓ �226_66,q_ Phone ..... <br /> Installation will serve: Residence Apartment House 0 Commercial C]Troiler Court 0 <br /> -Motel E]❑Other__............ ........ ............ <br /> Number of living units-_,/....... Number of bedrooms -3-------Garbage Grinder Lot Size ......... <br /> .............. ....................... <br /> ............. ---------- <br /> Water Supply: Public System and name ...._ --- - ------------ -------------I............................................Private <br /> Character of soil to a depth of 3 feet, Sand 0 Silt El Clay El Peat❑ 'Sandy Loam X1 Clay Loam <br /> Hardpan 0 Adobe E] Fill Material If yes, type ------_...... <br /> (Plot plan, showing size of lot,. location of system in relation to wells, buildirf gs, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feetj <br /> PACKAGE TREATMENT SEPTIC TANK i J Size.., liquid Depth ................ <br /> Capacity ..11;2 4��P, TYPOPle ��'??7MOterial-----_------- - ---- No. Compar-tments .-..Q............ <br /> %n <br /> Distance to nearest. Well 1115-6...........................Foundation../o--------------- Prop. Une_s> ........... 0 <br /> LEACHING LINE No. of Lines .. ...... ... Length of each line.._i�d...............- Total Length <br /> 'D' Box ..... Type Filter Material Depth Filter Material <br /> Distance to nearest. Well Foundation ....... --- Property Line ................. <br /> SEEPAGE PIT Depth Diameter ................ Number ....... Rock Filled Yes 0 No wool <br /> tTableI 05 <br /> Water <br /> Depth ......... <br /> ............... ...............Rock Size ...___­1.................. <br /> Distance to nearest: Well ------_-------------- -_---_- --Foundation .................... Prop. Line <br /> ft' - - ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit#,` ­- - - --,......"I------ - ....... Date __________________________•____._.I <br /> Septic Tank (Specify Requirements) ..... ------------------------ ---------------­_1....................... <br /> .......... <br /> Disposal Field (Specify Requirements) .`---------------....._..._-•----"-•----y.................... ........... .......... .. ............. <br /> ------­------- ...................... ...... ........... .... ....................... ------I...... ................... <br /> ............. <br /> ........... ............... . ...... .. ............... .................. <br /> ........­ .....T__---------I--- ------------------ ............ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and tho"t the work will be done in accordance with'San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations <br /> Wrfhe Son 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 become subject to orkm 's Copensationjaws of Califirnici�." <br /> Signed <br /> -------------- --------------------------- Owner <br /> By ..... <br /> ­_­­............... ........ ..................... ..... ... .... ........... ............. ..... <br /> (if other than owner) <br /> FOR D9PARTMENT USE ONLY <br /> APPLICATION ACCEPTED By 7 <br /> 3 <br /> ----------- ------ ......... ........... DATE ...... <br /> ........... ........... ------ <br /> BUILDING PERMIT ISSUED ... <br /> .---------- <br /> -;-_-—-.- .............. ------7 ....................DATE ......f....................- <br /> ADDITIONAL COMMENTS ................:!�.A <br /> — -.7,-r--I ..- - . ----:._,W....................... <br /> .............. --------- ........................................... ....... .........­........ ..................................... ........... <br /> ....................•-•-.-----•--.._..----•----....-----•---------­---- ------------­­­...... ... ....... <br /> ......................................... <br /> ----------------- ..... ........... -------- 116�1 <br /> ................­- --------------I...... .......... <br /> ......................................­­­----------- <br /> Final Inspection by; ---------------• ---- Date ... ............... <br /> SAN JOAQUIN LOCAL HEALTH. DISTRICT- <br /> E. H. 1.3 24 I.-jsa R.,, -ea SA <br />