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"' FOR OFFICE USE: APPLICATION FOR' SAWATION PERMIT <br /> �;. 5 <br /> Permit No <br /> (Complete in Triplicate) <br /> . ..................... <br /> islJ' 73 <br /> ------ This Permit Expires 1 Year From Date Issued ,�� '`; """' <br /> c J eS S ,G.D - <br /> App�ica on is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with ounty Ordi nce No. 549 and existing Rules and Regulations: <br /> .JOB ADDRESS/LOCATION .....CENSUS TRACT <br /> Owner's Name ......................... . . -------•--•- ..._.. , Phone ?(r '.. .1. Q........ <br /> lI ,..... <br /> Address ----- .........G....T•-. . ............. ................... City ............-•---.....----••-----........... <br /> t S .c�' --3C.lard 7 <br /> Contractor's Name ........................License # _y....__� ._. Phone - ------ •- . ....... <br /> Installation will serve: Residence X Apartment House 0 Commercial ❑Troller Court 0 <br /> I Motel C] Other ...................................... .•-- <br /> Number of living units:....!--.__. Number of bedrooms ... ;.....Garbage Grinder ............ Lot Size ...� ----­------­--­--- <br /> Water <br /> - ------ -------Water Supply: Public System and name ... ....... ...............------------------------------........ ............................................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt[3 Clay ❑ Peat❑ Sandy Loam {] Clay Loam D <br /> Hardpan ❑ Adobe ❑ Fill 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 permitted if public sewer is available within 200 feet,) 1r\ <br /> PACKAGE TREATMENT [ } SEPTIC TANK f j Size............ ...... .................... Liquid Depth ..........._.............. <br /> ._.. Material...................... No. Compartments ........_..... <br /> Capacity -------------------- Type ---------...--- P ........ <br /> Distance to nearest: Well .................................Foundation ......... Prop. Line <br /> LEACHING LINE [ } No. of Lines ........................ Length of each line----------------------------- 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 ❑ No ❑ <br /> Water Table Depth Rock Size <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) ...................................................... <br /> Disposal Field (Specify Requirements) ............ .. �__-.-.. ..__...... _. <br /> ----------------------------------------------------------------------- . Q_....._' �� ..........._.._._. _. _....._.... ---------------......................... ^ <br /> G 1�c� --c <br /> ........................................................... ............. <br /> (Draw existingreauired�dditon rse <br /> 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 local Health District, Nome 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, 1 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 <br /> (I o her than owner] <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. ...... ...... .. ...................... ............---- •.................................... DATE ...��... ..., ............. <br /> BUILDINGPERMIT ISSUED -----••-------------------------- ----------- ...........................................................DATE ........................................... <br /> ADDITIONALCOMMENTS ....... ----------------------------- --------------------------.......---•------....-------•-...._....._..._......--------=•._.....__....-------_..._. <br /> ........................................................ •---•---------------------------------•----------------------------•---•-----------------•-------•--------...-------------•-------------..._._._. <br /> --------------------------------------........... ... . ....•--•--=---- - ------------------------------....---------------- ----------•------------------------ .. <br /> ------ <br /> --•-------- --------------------- ------ ---------•--•-••---•--- -•--.---•-- <br /> Final Inspection by: <br /> ....--- Date . _., :. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.Z3 24 1-'b6 Rev. 5M 7/72 3 M <br />