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- •gyp. <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. 7 3..�`?7 <br /> ".. .."...."........".............. (Complete in Triplicate) <br /> ....."................"...... �3 <br /> F Date Issued .. ..'.....__...:. <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a per to construct and install the work herein <br /> f described. This application is m e in compliance with County rdinanc No. 549 and existing Rules and Regulations: <br /> • r <br /> J ._. .....:......... ENSUS-TRACT <br /> ....� �....- <br /> JdB'ADDRESS/LOCATION .: ..���"...�.� Q lei---- .................... <br /> Owner's Name r.7/.- P....all ---------- ................................................:.....................Phone .................................... <br /> Address .................... . ._. ., �5'� ......-•-•------"-. ......... City -,SF*. --"".... ...................................... <br /> Contractor's Name ... .-C!Yl .".....License # .� •----- Phone � �f ..... <br /> d...." .... �• ... . <br /> Installation will serve: Residence Z(P'artment House❑ Commercial ❑Trailer Court �] <br /> Motel ❑Other ............................................ <br /> �/X. .... <br /> Number of living units:---/.---- Number of bedrooms .v Garbage Grinder ... Lot Size..""._../ <br /> Water Supply: Public System and name ""-..._._..""--••----...-•"--•-----••--....__.""..•..................".._Private <br /> Character of soil to a depth of 3 feet_ Sand ❑ Silt❑ Clay C] Peat❑ Sandy Loam C1 Clay Loam ❑ <br /> �.._. <br /> -�— R Hardpan Adobe ill Material ............ If yes,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 INSTALLATION: {No 'septic tank or seepage pit p rmltted if puhlit sewe is available within 200 feet,),`' J <br /> PACKAGE ITREATMENT { ] SEPTIC TANK ize...; �J ---••.... ...-• Liquid Depth"1Z--•-•••--•------.J <br /> Capacity .���"...... Type <br /> ..et( . Material_f�h - No. Compartments.............J <br /> ! DAstonce to nearest:•Well ,0..i...... ........Foundation Prop. Line .;/ <br /> Length of each line. 'Total Length �'.�...•--.....•-- f ' <br /> LEACHING LINE No. of Lines _.ci ....""""""..._._ g >.�-•__..._"..: <br /> 01 0 <br /> V. Box .[,fir".. Type Filter Material Aa........Depth Filter Material _a......................................o <br /> a <br /> �/ . .' <br /> Distance to nearest: Well _0........ Foundatiort��: _................. Property Line ._ _........ ....... <br /> Fj` <br /> SEEPAGE PIT IL)/ Depth ... ...�.:..... Diameter.`......_._ Number ----- .:-"- Rock Filled Yes 0---go ❑ '#•. <br /> • Water Table Depth ._...- !l... , .... ............Rock Size._ ..1� ................ <br /> I T <br /> Distance to nearest: Well ......Foundation _. @..�.."_ Prop. Line .,�..._.__. <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -I.........................................- Date .................................. <br /> s <br /> Septic Tank (Specify Requirements) .........................................__._..__....--n--•.....--------.......-.----•-----......_.....------_.....:..---•--•-- <br /> Disposal Field (Specify Requirements) -------- -•-• --------------------------------- .......................................................... ......................... <br /> --------.."--------------- --"----"-- ••--•-••----- ."----........ <br /> ......------...-..--------------------- .... . <br /> ........................ ..... <br /> (Draw existing and required addition on reverse side) ," <br /> 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 LocallHealth 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 Workman's Compensation laws of California." <br /> Signed ........... -_--------- " ------ _- :.. .......... Owner � <br /> BY ... .-_---•-------_-- - title ... �J���..._:. <br /> (!f of an owner) <br /> FOR DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BY ..-.. ..... . ..............:......••---------•----------•-- DATE ...: :... <br /> BUILDING PERMIT ISSUED ... <br /> ..............DATE .... ............... <br /> ADDITIONALCOMMENTS............:..•• •--•----•••-•----•-•.._............ --...........--------.... ............. .......................... <br /> - ------------------------""" -- :.... ....--"---....---•.------........."""............ ,.i--•- <br /> •..... ............ <br /> Final Inspection by: ...:--- _ ..--•---........ .----......."....----•--"".................•".Date . - ... <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT <br /> r u­11-241.1.�,•�, ".'rte_ sit �.p,,. ., ,,:,, ,.. .� 3-H <br /> --. <br /> •� _ 'x:72 3-H <br />