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S FOR OFFICE USE: <br /> APPLICATION MR SANITATION PERMIT Permit No. 7 <br /> 3 <br /> 3 4� <br /> t - <br /> (Complete in Triplicate3 <br /> . � <br /> This Permit Expires t Year From Date Issued Date Issued .!�5 . ......5.. <br /> Application 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 County Ordinance No. 549 a d existing Rules and Regulations: <br /> s <br /> pry _ <br /> .SOB ADDRESS/I.00ATION ..... t ...fj�.. _.....,._ CENSUS TRACT .......................... <br /> t Owner's Name .... ...... ..._...........-- T _ = ...._.__. .................Phone ................................._._ <br /> .. <br /> Address .......----•...............................•-- .... ....•.._...--•--...._......... City ........................ .......................... <br /> Contractor's Name -- , `� f/` Ct` ---•-----•----••-- License i l�� i �.. Phone _. ��1 .........7�� <br /> �r <br /> Installation will serve: Residence❑Apartment House 0 Commercial❑Trailer Court ❑ <br /> Motel ❑Other .---•......................:.... <br /> 4 w+^I <br /> Number of living un'its:_._ __ Number of bedrooms Garbage rinder ......... Lot Size .p-_� .�. 1:............ <br /> i <br /> Water Supply: Public System and name .......4.I. �.`!�7.!�h._---W - f�:.. .........................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand b Slit o Clay ❑ Peat❑ Sandy Loam a—Clay loam ❑ <br /> Hardpan fl Adobe 0 Fill M4terlol yes,type..._.._...._ if es a............... ............ <br /> (Piot plan, showing size of 'lot, location of system .in rotation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: ( <br /> No septic tank or seepage P <br /> pt permitted if,public_sewer is available within 200 feet,) <br /> i <br /> PACKAGE TREATMENT ( ] SEPTIC TANK I ] Size._._:_:......_. .. ....................... Liquid Depth .................. <br /> Capacity p ty/.f <br /> eP . Type Material........ •.......... No. Compartments........... 0 <br /> Distance to nearest: Well ...Foundation t e2 ....... Prop. Line ...�........... <br /> LEACHING EINE j ] No. of Lines - � . Length of each line.-/ ��......... .. Total Length ..............� <br /> 'Q' Box Type Filte Material Depth Filter Materia( <br /> l ............. <br /> i Distance to nearest: Well Foundation --...--••- ... Property <br /> Llne 1'Q...... <br /> [ ! -._ ....�.................. Rock Filled Yes 0--"No 0 <br /> Diameter ................ Number <br /> SEEPAGE PIF Depth� aL.?�. p Uiomete . <br /> f <br /> Water Xable Depth #txk Size ................................ 0 <br /> .t ,.,-•---•- <br /> Distance to nearest: Well ...Foundation .. Prop. Line F <br /> k REPAIR/ADDITION IPrev. Sanitation Permit# ........................ . Date \11 } <br /> P <br /> Septit Tank (Specify Requirements). -----•- ------ ----------- ........................ ------- '= ...... •---••.._..............._....•--.......... <br /> > i ' <br /> Disposal Field (Specify Requirements) ----------- ----------- -`----..... :..................._._..........._.............................I........... <br /> ------------ ----------•-•------- ---------•-••................................. ...........•-------------- ..............................•................... <br /> .... <br /> a <br /> F --•---••------------•-------------------------------- - -- ------------------------------------..._._ :.............._. ,...........----••-----........................- ......... <br /> ! (Draw existing and required addition on reverse side) <br /> f I hereby certify that I have prepared this application and that the w r#c�ll be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules-and R60416-tions of the San .Joaquin Local Health:Dlslrict. Homo owner or Ikon- <br /> sed agents signuturo.certif€es the following: It <br /> �•., <br /> "I certify that in th@ performance of the work'for which this permit is issued, I shall no�t employ any person In such manner fa <br /> as to become s b t to Work 's Compensationlaws of Californla." <br /> Signed ----•-- .:. ... ... ------------••----•-----•--- Owner <br /> By ....................... ----------------------------------------------- --------•-•------- ........... Title _..-------- ----...__...---- ...---._... .......... <br /> ,r(If other than owner) <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- --- A-- 1...-...... . ........... .........1. HATE ,.._�� _.. -5............. <br /> BUILDING PERMIT ISSUED --•------------ --------------- DATE _...---...._ .......... . <br /> ADDITIONAL COMMENTS --------------------------------- --- -"-------------------•----...... ........... .......=................... <br /> ---------- ••--•-•• -"..................•--=--._....._......._......--•--_._...---- ........"I...... <br /> ........................•---- - - --------------------- -----._......_...._..._..__I......----•---.� ` <br /> by. .e.-- -- - .. .. <br /> ................................•----�--- .--- •,�„--•-.._._ <br /> Final Inspection . . <br /> 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH, DISTRICT _ 8/7h 3M_ <br />