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FOit OFFICE Ll <br /> .. APPLICATION FOR SANITATION PERMIT: <br /> lContphttiiti Triplicatel Permit <br /> . '. .......... <br /> ........................... .. .. ---�` This permit Expires Z Year From Date lssded: Date Issued ����:..... } <br /> ::: - , <br /> .WAOplkotion'ii hereby made to the San Joaquin local Health District for a permit to construct and install the work herein V <br /> `described. This application is made in compliance <br /> wiith County Ordinance No. 549 and existing Rules and.Regulationss 4 <br /> JOB ADDRI"5S/LOCATiO ................d .. .. ............................. CENSUS TRAG'f <br /> Owne'r's Name .._ .. 1..x.7. ... e.l�!`.. .. . ,.. .:. ... ....Phone ........ . ......... ..._.. s <br /> 'Address . .�`�:.fir ....., ..........� -w-.-~-�.City •r lr1 .....:................................... <br /> ......... <br /> Contrcictor's Name... `•' -•, r 1 .�e.,10 ..........................LIcense'4a.7!.��. Phoria L...,. ............... <br /> Installation will server ��.v _� Residence Apartment House(] Commercial OTrallw Court <br /> Motel0 Other....... ..................................�. <br /> Number of living unitsr_ 1....... Number of bedroorilts _...Garbage Grinder ..... . .... Lot Size <br /> Water,`Suppiy: Public System and name ,.. ...... ., ` ....._ .. ....... ......:.........:......1'rhrate <br /> ..�„. i <br /> f .. . <br /> Character of sail to a depth of 3 feet: Sand t] -- Silt Q Clay a�' Peat[Q,, Sandy Loam o_-Clay Loam. ' <br /> 4.-Hardpan 0 Adobe 0 Fill M6terlai .�.:......::!# t <br /> mak+ t <br /> (Plot plan, showing slze of lot, location of system in rotation to wetls; baitdings, etc. must be placed on reverse ilde.3', <br /> NEW lINSTALUITIONt (No septic tank or seepage pit permitted if public *ewer 1s available within 200 fed I <br /> PACKAGE TREATMENT SEPTIC 7AN1C ,. "': �Llquid Depth <br /> ••• ��.--- <br /> capaNty f/.` x. ... ._,Type E".° *nnmfeftl.. f. '._ No. �Cais�partmeMs ,..I-:: ..... J <br /> Distance.fa noarest:�Well ......... !?�� ..... ....Foundation .`..:... Prop. Line .. .�.r ~...:. <br /> LEACHING LINE ( ] No. of Ur.as{` ._ a isengt#i+afjaach."ltpe..._. �1.. ...��. Total .Length . <br /> `D' Box �F 9. Type FIItgi Mater€al,,f ; _..Depth` ,Filter Material . .¢...... ......:.. .. .... : <br /> Distance to nearest, Well ....t�...o� : . Foundation ... .?,.-. ........-- `Property Line ..:.r . ... <br /> SEEPAGE'PIT [ ] Depth ...f:.... . .... Ow"ter �',kO(Vgumber ...... 1..................'.Rock Filled Yes No <br /> Water Table Depth ..._..�19...............:i..........""�4i Sfze C e . � 7e <br /> Distance to nearestr Well ....f � ... ......:...:_fouitdat€on :ate:�� ` prop. Line �� �.... <br /> � - <br /> REFAIIII I"QITIQN(Prov. Sanitation Permit t# ..... ... ................ Dots ................................... <br /> =: <br /> Septic Tank (Specify Requirements)....... .:.... �%'...... ..........:. ..... r <br /> .... _ ....... <br /> ,.: <br /> Disposal Field (specify Requirements) . <br /> � ........����....... <br /> �r�` <br /> / (Draw existing and required addrzr <br /> nn reverse side) . <br /> I hereby certify that l have prepared this application and that the work wNl be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Satz-Joaquin Local-Heahh.Wstrict. Homo awne`r or liam <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 ..................................................... .....................Yide ......_........................_.. <br /> (if other than owner) _ <br /> FOR DEPARTMENT .USE ONLY. . <br /> APPLIBUILDING ,. DATE ...._... <br /> CATION ACCEPTED BY _......_-• .�.. . ..... .. : . 7.�-.„-„„---- <br /> PERMIT ISSUED DATE ...... :....... ...._.... ....... 4 <br /> ADDITIONAL COMMENTS ............................... <br /> ...........Y.: - ........._..._..._......--.--•----- ..... <br /> ................ Lf T <br /> .................................. e,d .. ... _. .. ._.. .................... ---._......__.......__.._...._........_._._..._....-- ... ..... ... ._ ................ ........ <br /> Final Inspection by,.-.....m:� .!!; ... Date <br /> . .. •...... .. .... .... --- --------.-...._.-. *.......... �: :�: � :'1:' <br /> Ell 13 24 1-68 13ev-Y.���, SAN JOAQLIIN(.00AL HEALTH DISTRICT � � 8�7�1# 3M <br /> T <br />