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F# <br /> FOR OFFICE USE: r 4,. <br /> APPLICATIQN=.FOR SANITATION =PERMIT <br /> - ---- -- -- - - --•- Permit No: .7---�------------ <br /> (Complete in Triplicate) <br /> --------------------------------------------------------- This Permit Expires ] Year From Date Issued Date Issued <br /> X 5-3 t <br /> Application is hereby made to the San Joaquin Local Health DisMitt fa 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 Regulations: <br /> JOB ADDRESS/LOCATION jPIL I_ �-- <br /> � �✓--- -�,� - -�`� A -- *-4 <br /> -'- . -'/��'lA--° '�N�sUS TRACT ---- --- <br /> -------- --•--- <br /> Y --- <br /> Owner's Name � -------------- = <br /> -------------------------- - -------------------Phone ------------------------------------ <br /> Address ------�621?. ----- :� City.it,.: ----- <br /> Contractor's Name - -`---- -- ��4 ' License #0741,x-, ,Phone ------------••------••------- .. <br /> Installation will serve: ResidenceApartment House�❑ Commercial ❑Trailer Court ❑ <br /> Motel 1❑ Other ------ ----------------------- ------- <br /> f <br /> Number of living units:----/_._( Number of,bedrooms _____Garbage Grinder/O'er_ Lot Size _/-.0_"&1°e---__________________ i <br /> Water Supply: Public System and name ------ -------------------------------------------I----------------------------------------------------------Private,° <br /> Character of soil to a depth of 3 feet: Sant 0 Silt E] Clay E] Peat E] Sandy Loam -E] Clay,Loam:❑ <br /> Hardpan E] Adobe A Fill Material ---------- If yes,type ____________________________ <br /> 01 <br /> v <br /> (Plot plan, showing size of lot, location of system in relation to wells, Ouildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No se tank or seepage pit permitted if public se wer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK Size_ --------------------------------------------- Liquid Depth __________________________ l.J <br /> ------------------------- <br /> � � fk '�,� <br /> Capacity,/Z_a�___ Type __ - Material deo . No. Compartments ___` -_____________ <br /> Distance to nearest: Well __________ _ ______________Foundafiion `E _�________ Prop. Line _-� ............ <br /> LEACHING LINE No. of Lines ----- -------------- Length of each line---- i _------ ------ Total Length ,/'�w__`_______-_-__ <br /> 'D' B!x _Z _ Type Filter Material 1 � _Depth Filter Material ,��`6�____ ___________________________ , <br /> Distan a to � <br /> nearest: Well -- f Foundation ---------- Property Line ___ _ ___________ <br /> SEEPAGE PIT Depths-___ _ Diameter -.�..�_`'_ Number --------- <br /> .__ �_ ____________ Rock Filled Yes ' No i❑ <br /> WaterT6ble`Depth `r ------- Rock Size -.����' r <br /> Distance to nearest: Well ____�, P___-________________•Foundation __f ____ Prop. Line _ ---------------- <br /> It <br /> REPAIR/ADDITION(Prev. Sanitation Permit#._._____:________________ _ ____________ Date -------------- - <br /> Septic Tank (Specify Requirements) --------j--------------------------------- <br /> ------------------------- -- y= --------------­--------------------------- <br /> Disposal FI; (Specify Rrements) - <br /> ---- ------------------------------------------------------- <br /> � r <br /> ------------------- --------------------------------- <br /> ---------------------- t---------- <br /> -----=---------------------------------------------t---------- -- ---- ---------- ----------------------------------------------------------------------------------------------------------------------------------- <br /> V. I (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 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,rthe,_SanxJoaqum _jocall Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> ".1 certify that in the. performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> Lasto become subject to Workman's Compensation laws,of California." <br /> Pi 1Stgned -------------- -- - --- ----------- --------. Owner <br /> � <br /> y --------------------------------- Title ---------- ,/Ac�& <br /> (If oth an owner . <br /> FOR DEPARTMENT USE ONLY ll <br /> APPLICATION ACCEPTED BY ---' - - - - ----------- --------------------------------------------------------------- DATE A.k 11 VIX------------------- <br /> BUILDING PERMIT ISSUED ----- ------------------------------------------------ --------------DATE ----------------- ------- -------- <br /> ADDITIONAL COMMENTS ------------- <br /> ---------------------------------------------------------- ----- ^"-------------------------------- <br /> --------- ------- ------� ----------- <br /> -------------------------------- <br /> - ------ -- -- ----------- -- <br /> fnr -- ------------------- <br /> Final Inspection by: Date ° <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F' <br /> E. H. 9 '681Re�.-5M . ' '` i' � ti . ..• b <br />