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F R OFFICE USE: <br /> r y ,. �� :eAPP1LICATION FOR SANITATION PERMIT / <br /> - Permit N��.:��•••-• <br /> `.. -- (Complete in Triplicate] <br /> .-........--•.............. .......•-- Date Issued . 3U 7�� <br /> ......pp.................. ...... <br /> This permit Expires I Year From Date 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 mo in co liance with County O Ynance No. 549 d�existing Rules and Regulations: <br /> 1SUS TRACT ................ ........ <br /> JOB ADDRESS/LOCATION . �} <br /> Owner's Name ............. - I ...... --•--•--....:.:_.. ... <br /> Address .-..... - . . _....1 /Q�1CY- ../..IO.......t''-�• <br /> ............ city City ----- • '- .... <br /> Contractor's Name .............. k.Y ell-�'..........--. <br /> License # a - �." .'Phone <br /> Installation will serve: Residence 16 Apartment House❑ Commercial ❑Trailer Court ] �. <br /> I Motel ❑Other -------- <br /> 5. <br /> F Number of living units:.-----.1.... Number of bed Gams .._ ._ rinder ---..-_---- Lot Size .-_. <br /> .. r..... .......................... <br /> ----•Galtr9e G r <br /> Water Supply: Public System and name ' `fg ..f'----•-------- - - ..... - =... ....... <br /> private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay Peat C] Sandy Loam fl' `Clay Loam`❑ <br /> Hardpan E] Adobe C] Fill Material If yes,type ....- :=--,----••• <br /> buildings, etc. must be placed 'on reveise side:} ` F <br /> (Plot plan, showing size of lot, location of. system in relation to wells, g - �✓ <br /> NEW INSTALLATION: (No septic tank or seeps a pit permitted if public sewer is available withinfl0 feet;)` r� <br /> Size.. _.9.:?�_ :..- ....--.......-_ LigA Depth .! •-,: - O <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t <br /> xCapacity ..-� �--••- Type l�P.CG - Material.cv?v-f7e-`-- No. Compartments ...:.12,.... 4 <br /> . � <br /> •---•. <br /> Distance to nearest. Well .._.-...... .............Foundation <br /> Prop. Line ...... ....... <br /> - <br /> Lang ................ <br /> LEACHING LINE [ ] No: of Lines ...—P----------- Length of each line.-------- <br /> r� <br /> D' Box �.- Type Filter Material Sc ?<<s�a=�`-Depth Filtef Material"`-_:.:1-:7....._.._..•-•••__ ........... ' 4' 4 <br /> r <br /> ` Distance to nearest: Well :..,�.-..cru------•- Fqund1 • - Propertyation <br /> • Line <br /> ut� ....__.... Rock Filled Yes No ❑ 'j) <br /> SEEPAGE PIT Depth .-- - DiameterT�_. _...... Number ..._....... ...-. <br /> < < - V) <br /> Water Table Depth ................ Rock Size .............. ` <br /> Distance to nearest: Well �G "FlAdatien ) •.... . Pr i e�--._----••--••••-••-•- 7 <br /> F REPAIR/ADDITION(Prev. Sanitation Permit# .......... Date .................................. <br /> f ' <br /> Septic Tank (Specify Requirements) ....................................-•-......_........ <br /> i <br /> Disposal Field (Specify Requirements) --------------- ............................. - <br /> ....---.................. <br /> ----------•------•......----.... <br /> ..-------................ ... <br /> ------------ <br /> --•----•••----------------•--•._...------. <br /> I <br /> (Draw existing and require&addition on reverse side) <br /> G 1 hereby certify that l have prepared this application and that the work will be done .in accordance with San Joaquin <br /> i County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or Ikon- <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 beta sub' ct W man's Compensation laws of California." <br /> Signed .. ...........•----- . Owner <br /> - <br /> By -•-------- .-.ner)............................................ <br /> -------• Title ..................... .................................................. <br /> .. . . . • ----.....- <br /> (If other than owner) <br /> POR D PART ENT USE ONLY <br /> APPLICATION ACCEPTED BY .............. .:- ----- ---- ................................................. <br /> DATE ............. <br /> .:..............DATE -------- .......... <br /> BUILDING PERMIT ISSUED ... ......__.........._. <br /> s ADDITIONAL COMMENTS .............................................................................................................................................................. <br /> -----•--•-- <br /> .-- --.. . .... <br /> •------- ------•.--...---__•-....._. --:•--• ......_... D f ------...... <br /> .... a e <br /> Final inspection by: -•--.........I........................ <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> !� <br /> 1 � 2G 7172 3 M <br /> r .. , ��e l�f_., eat ' _ •:� <br />