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FOR OFFICE USE: <br /> APPLICATION ICOR SANITATION PERMIT 7 7 <br /> ._..... Permit No. l <br />' ........................................... _ (Complete in.Triplicate( ...... <br /> / 7 <br /> h <br /> -- ..•. Tis Permit Expires ] Year From Date Issued <br /> Hate Issued _.....`----•_-- <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 and existing Rules and Regulations- <br /> lo <br /> JOB ADDRESS/LOCATION'.._ .. .... a........ ..... CENSUS TRACT <br /> f e. .............................. <br /> Owner's Name ..... .... .. ..........................................................Phone � @ ? 3 <br /> . ti �-gid•- <br /> r <br /> AddressiI ....... _. ... ............. .........................City _. ... . .. .........: .•....- ............. <br /> Contractor's Name ..License * ........................ Phone ......----------- ............ <br /> Installation will serve: Residence M)Apartment House❑ Commercial❑Trailer Court 0 <br /> ,Motel ❑Other <br /> Number of living units:_..._..__ Number of bedrooms _......Garbage Grinder ............ Lot Size <br /> Water Supply: Public System and name .--•-------•...... ...............:_......---•--------...Y................................------..............Privatex <br /> t]Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat.❑ Sandy Loam', Clay loam Q <br /> r _ <br /> Hardpan p 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 240 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Size_.. ._ <br /> Ca <br /> Liquid Depth .. <br /> aci .�„ G? -- T e(�r C. Materlal. ... r <br /> p tY yp o. Compartments .. ...... <br /> Distance to ,nearest, Well ____S_,Q./ .........Foundation�..�C���........ Prop. Line ........ <br /> LEACHING LINE No. of Lines __ ______________ Length of each Total Length ..7,/7-6:6-5/6d <br /> '.D' Box .... .. Type Filter Materials G_._.�Filter Material ..... ............... ....... . <br /> f Distance to nearest: Well ......•L O!..---- Foundation ........ Property Line .. ... ........... <br /> € SEEPAGE PIT 1[ Depth .__.................... Diameter _.....__._.._ Number ......................... Rock Filled Yes ❑ No 0 E <br /> l .� <br /> a <br /> ." Water Table Depth ................................................Rock Size ............. .................. <br /> Distance to nearest: Well -Foundation <br /> �- _..-•--------------•------------------- .........:.......... Prop. Line ...................... 09 <br /> i REPAIR/ADDITION IPrev. Sanitation Permit# ..... ------------------------------- Date ................................... <br /> Septic Tank ISpecify Requirements):_..---------------------------------'..._..--.:-•--.•................ <br /> Disposal-Field_(Specify'Requirements). ----- ----=----• - .............................................. .......................................-•-•.......... <br /> ..._.. <br /> r <br /> ----------- --------------------------------------_­­­............... ....._.................................................•.......... <br /> (Draw existing and.required addition on reverse side) <br /> I hereby certify that I have prepared'this.application and that jh87 work will be )lone In accordance with San Joaquin <br /> County Ordinances.. State Laws. and Rules arta Regulations of the San Joaquin Local Health,District. Home owner or licen- <br /> sed agents signature certifies the following: 4 . , <br /> "I certify that In the'performance of the work-for-which this permit is Issued, I %hall not employ any person in such manner <br /> as to become subject to Workman's Com• a sation laws of California." <br /> Signed - -------.-. - Owner <br /> .................................. <br /> By -------- . 3itle <br /> ------ --------------- ---------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _.__ .. .___. _ ` <br /> = . . DATE.:..... ......:77.._ <br /> BUILDING PERMIT ISSUED ..................................................... .................................DATE -------.---------------------------------- <br /> ADDITIONAL <br /> ..__----_. . -.ADDITIONAL COMMENTS ........................._- --------- ------------------------•-------_------ <br /> ......----•- ----------•-------------•------------------ ------------------------------•------. -_.._..---------- <br /> F ------------------ •----•-------•----------- -- _� - -----•-- - -•---------------•-••----------•------------------.._.. ---------- ---- -- - .---- <br /> Final Inspection by: . --• -------------•...................................Date ... ,r _..�. ._.._.. <br /> EH 13 2h 1-68 Idev. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />