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FOR OFFICE USE: APPLICATION FOR SAWITATION PRRM11' <br /> `10 Pe . .... -- ~� <br /> 1Complete in Triplicafel P it No 7� 3� <br /> _.. k.. . . <br /> ._:._. This Permit Expires I Year From Date Issued Date issued .�x�'............ <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 /> I`ASO <br /> JOB ADDRESS/LQCATION .. ........__.._.. ------ ........ ..................................CENSUS TRACT ....._ ................. <br /> Owner's Name . .................••------._.......----............-- --- .........-......--• ---Phone --AA1Tfl.. ...... <br /> Address -_ \ '..............................•--.....................-....City ---'.11V�.a....'-............ ......._-----...... ................. <br /> Contra dor s Name -------------------------------------- ------ --- -------.....License # ........ • .-...... ---- Phone .............................. <br /> Installation will serve: Residence❑A`partment-House `Ooh i 1•❑Ttc it C�i1rf—❑- <br /> ✓fs <br /> Motel ❑;Other :._ +_ .- L.. <br /> Number of living units:--- ------- Number of bedrooms _�------Garbage Grinder ............ Lot Size ... T,:..A L"... ....:....... ..... <br /> Water Supply: Public System and name .--••-•- -............................................---............................................. ....Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑- Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan Adobe, Fill Material ............ I# es e <br /> y ,type............... ............{ <br /> r <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] <br /> PACKAGE TREATMENT SEPTIC TANK Il } _..... Liquid Depth .........:.:........ d <br /> € � Size_.........--•--------------------------•-- <br /> Capacity �sz •-IType <br /> lA� � --. Material__ A,,-- No. Compartments ti... ........(.........� <br /> Distance to nearest: Well _.-- •-•-----•...............Foundotion ....�.d.�. ........ Prop. Line .� .�+".. ..... <br /> 01 1 <br /> LEACHING:LINE € No. of Lines .....I-------- ---_.__ _ g <br /> - Len th of each ime..__.•k�_-........... Total Length ..?. �.............• O <br /> E 11 <br /> ++qq <br /> D' Box ..... Type Filter Material .- Depth Filter Material ........1..1.....: <br /> Distance to nearest. Well t/ _ Foundation -._ -__-.-- Property line+`. <br /> SEEPAGE PIT € ! Depth .ate--------------- Diameter U........... Number .....�____...___.�r.._ .. Rock Filled • Yes No ❑ <br /> Water Table Depth �._...._ ............ ........Rock Size iX- <br /> Distance to nearest: Weil -----.......................•...........Foundation -------------------- Prop. Luis.................._..� <br /> REPAIR/ADDIflON(Prev. Sanitation Permit# _- ........................................ Date ..:.......................:....... <br /> ] <br /> Septic Tank (Specify Requirements).......•------- ------ ............................................................w...... -AS&4.O....... • ....----•------.......S <br /> u <br /> Disposal Field (Specify Requirements) ---------------•----•-•-------•-- -•-•---- ------------------------,...... <br /> = <br /> --------------- ------- ----- ---•-- <br /> # _ I <br /> --------•------------------ <br /> trt <br /> ((?raw existing and required addition o reverse sidef <br /> I hereby certify-thata-.-have-prepa'*m this.ppplication and that the work will be done in accordance with Sian 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 <br /> "I certify that i e performance of the work for which this permit is issued, I shall not employ any person In such manner ' <br /> as totbeco su ect t Compensation laws of California." <br /> Sigred�� - <br /> .- - - ---- ------ --• - -------------- --•---•---------------- Owner <br /> BY ----- ---- --•-------- <br /> (if other than owner) <br /> FOR DEPARTMENT .USE ONLY <br /> APPLICATION ACCEPTED BY '1~ -•----- ----------•--.........................................DATE ..,._..�.- ................... <br /> DATE <br /> Bl1lLDING PERMIT ISSUED ---- ---- ...................•--......_.. <br /> ADDITIONAL COMMENTS ------------------- --------- - - _ <br /> •------------- <br /> - <br /> ----- <br /> --------------------•---'... --- -• •---' ................................................... <br /> _ - <br /> Final Inspection by: .--- t .. .... :.:.......•..__... _ �' <br /> Date ../- <br /> -------- <br /> EH 13 24 1-68 v. SM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />