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FOR OFFICE TSE: <br /> APPLICATION FOR SANITATION PERMIT <br /> f' JComp#ete in Triplicahf. _ P mit Na. ._.7:S~73 b <br /> ��=.. . � :j Date Issued J;.—c6. 7 <br /> 'This.Permit Expires 1 Year From Date Issued r" . <br /> Application is hereby •• <br /> pp h y 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 Co ty'Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/L0CAT30 /.._/. CEN5<JS TRACT 4 7- f-- .. •---••---••-_....-.._......_. �........................ <br /> Owner's Name ............. ........ - ..................4---............:._... ..... : ho .� . ..--••-- <br /> �' .CLQ. <br /> ty _ <br /> Address .................... :.. _ __. .... .....Ci _ _ :.{'.i.... ........_- ..._..•-••••--•-- <br /> Contractor's Name ?-•.___.... ....' n Phone � �J? <br /> 7 <br /> i. ' License <br /> ` 3__ - f <br /> Installation will serve: Residence pa'rtment House 0 Commercial❑Traller � <br /> Mote p Otherrt_s.A.*/ . <br /> Number of living units:.... -_-._-- Number of bedrooms -___.:__Garbage Grinder -----_---._ J&Size .... <br /> �, •---��- <br /> Water Supply: Public System and name/ O Private ❑ <br /> Character of soil to a depot)f 3 et: Sand b Slit 0 Clay ❑ Peat[3 Sandy�L'aam 0 Clay Loam 0 <br /> Hardpan[]/ Adobe Fill Material ............ If yes,type?................. <br /> n. <br /> (Plot plan, showing size of lot, locationi'-of system in relation to wells, buildings, etc. must be plated on reverse side.) <br /> NEW INSTALLATION: (No septic tank sepal f-pit`permitted if public sewer is available within 200 feet,) <br /> / . I __ <br /> PACKAGE TREATMENT j ] SEPTIC TAMC -i S' e.______ � liquid Depth .......,:_.__ <br /> Ccpociry r .(•_-_ Type .1 .... Material..-��Q �:I No. Compartments . :__.. ....... <br /> Foundation.�Q..::} t`K_!Prop. Line _'a5�.r.--... <br /> Distance to nearest: Well .:.._. <br /> I ! <br /> LEACHING LINE No. oftines ... .......... Length of each line...---- ..: ........ Total Length!_./7v...........:.... <br /> M�te`rial,.��. --.De Depth Filter Material '" <br /> D Box ` . Type Filter p I ........................ <br /> Distance to nearest: Well -----------------------=- Foundation ...1�..:" ` operly Una .._. ........:.. <br /> SEEPAGE PIT Depth _____ .. Number .... . Rock Filled Yes No iO <br /> ,[- ...... Diameter . ... ......... 7�_._.. _ <br /> E t / <br /> Water Table Depth :.--Rock Size 3 �r ....I <br /> Distance to nearest: Well ...--.:-----•------........................Foundation--/A.t7..._. Prop. Line .:..5.7' .. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .......................................:.... Date _-•:--__--- -------I_.._____-•-_} <br /> Septic Tank (Specify Requirements) -----•_--.......... -•........:...:...•--•--......._..-------.._.................-._ ........... ..........._..._.:........._. <br /> Disposal Field (Specify Requirements) -•-•....................•--• ............................... ...................................._....... <br /> . <br /> ----- <br /> --------------------------------_--------------------------------------------------------------- . C ?...........------•-- <br /> (Draw existing dna required addition ori reverse sidel <br /> I hereby certify that I have prepared this.�applicaticin and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:Dlstrict. Home owner Or Ilcew <br /> sed agents signature certifies the following: t <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 % `w-----" . ' R ---.... ----------------------- J':itle --•-------- ----`•---- ................-----•------•-----. ----- <br /> (if o than owner) <br /> FORIDEPARTMENT USE O LY <br /> APPLICATION ACCEPTED BY -1--1-.1---. <br /> -- --- ------ -- - - _--_ ___DATE <br /> �._.�. ..,-'....��. <br /> BUILDING PERMIT ISSUED ---- ------------- -_DATE .--------------- ........................ <br /> ADDITIONAL COMMENTS _... - •--------- _---=`------------------••-- --• • •- . .._............•-------.-__ --------:. - <br /> + sS <br /> r <br /> -------------------•--•---------•-- _ ---- ---- ---------------------------------------------......-._.. ..._.. <br /> •---- -... <br /> Final Inspection by: -•------ ----• •••-- Date .------. <br /> 13 21� 1-6#3 SAN JOA UIN L�- -. <br /> EALTH DISTRICT 8/7h 3M <br />