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_4-.MK OFFICIO USE: <br /> APPLICATION ICOR SANITATION PERMIT <br /> ... .............................................. [Complete In Triplicate) Permit No.75 <br />_........_,............................................ Date Issued <br /> _ ... <br />.........__......................I....................... This Permit Expire; 1 Year From Date Issued R <br /> Appllcatiori is hereby trade to the San Joaquin Local Health Disirict 'for--a-,perm€t• to construct and' install the work herein t <br /> described. This application is made In compliance with County Ordinance No. 549'tend existing Rules.and Regulations, <br /> J08 ADDRESS/L ON7ID ..... .... h .... ............................CENSUS TRACT ......................... <br /> Owner's Name .... l.. x. ............ :..............Phone .............................. <br /> Address .............. `71�... . ............ ~ .._A �. ......... --rOhr .. ....................................... i <br /> Contractor's Name --- - .. z-� :.� ..Livens_e .f.S ?- Phone .............................. <br /> w t <br /> Installation will serve: Residence 0 Apartment HpusoQ Commercial E)Trailer Court,0 � <br /> Motel Q Other--- :- - __- A � <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ..... ...................................... <br /> . ' 7 <br /> Water Supply, Public System and name ........................Private <br /> Character of soil to a depth of 3 feet: Sand -'Silt❑ Clay ❑ Peat ] Sandy Loam ❑ Clay loam <br /> Hardpan Adobe❑ Fill Material -....... if yea,type <br /> (Plot plan, showing size.of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONs (No septic tank or.see go pit permitted If.public sewer..is available within 200 feet,) <br /> PACKAGE TREATMENT [ } 5I:PTIC TANK# <br /> Size.,l.�':. _ .. �`-.�.. =.:..-_. liquid Depth ......E................. <br /> Ty <br /> k-�:�__�..... Material... �.. No. Com <br /> Capacity partments a----------=------ i <br /> .: �A.::.` —� <br /> Distance to nearest: WellD._ f <br /> ........Foundation . _/. ............. Prop. Line _ ............ .0 <br /> LEACHING LINE [KNo. of Liles . ._.... - Length of each line.......�Z 1.......... Total Length ....'T..�............ J <br /> 'D'iBox..-r=te....�Type,Filter Material .... ..K....Depth Filter Material .....129...`.'.............. .........:0 <br /> t "Di"s4nr}ce`to nearest=-well`.....S�p.�........... Foundation 'l�j � <br /> • • Property Line ................ <br /> SEEPAGE PIT Depth ...... S. Diameter Number .........1.................. Rock Filled Yes No Q <br /> Water Table Depth ...............q.f.......... ---..........Rock Size � ._j.�- ........ <br /> .�. ....... <br /> � f <br /> /___0_' _ .- 'Distance to-nearest::Well..!...._....�: <br /> Q r ..........Foun�dation, . prop.. line � . i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..............................' <br /> • ......•.... Date .........---...................... <br /> l a <br /> Septic Tank (Specify Requirements) ....................6.................................................................. .....-. :._ <br /> ... ............._................ e4, <br /> DisposalField (Specify. Requirementsl ............................................................:........................................................................ <br /> ---------------•.......................................................•-----------------..._......------•---•-. ................... .............................. <br /> .....-- -- . .....__.._.... f <br /> ..........-•-----•--------•-•------------------------------------------ ......---...-.-•---...----........--••••......•---•-... ....................................... <br /> (Drow existing and required addition on reverse side) i <br /> I hereby certify that I have prepared this application and that the work will be done .in accordance with San Joaquin 1 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen. <br /> sed agents signature;certifies the following: <br /> "l certify'that In the.perfarmance of the work for which this permit-is Issued, I shalt not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ......................... .- ..........:I. ........ <br /> .. Owner <br /> By _...:......... ................ r... . S€tie .. _ .. ...... ..:..:':::............ ............ <br /> I <br /> (If other than owner) <br /> i <br /> FOR DEPARTMENT USE: ONLY <br /> APPLICATION ACCEPTED BY............_ .-.� :..._.. DATE.....�� .�aZ, ..............j .-.._ ! <br /> BUILDING PERMIT ISSUED ...................--....... DATE _. _. <br /> ADDITIONAL COMMENTS ' <br /> .................................._.................---'•-------------..............-----. --------------:-...... --.... ...--- ........ ...._.. .. . .... <br /> ... ... ..... - <br /> _.-----------.- <br /> Finalinspection by: ............ ....................................................................:............. .....DateEH ...�1� ./Q?, .. � ................ <br /> 13 2!a 1-68 3icty. _qM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />