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`�OR OFFICE USE: �. FOR OFFICE USE: <br /> Fv APPLICATION FORAAMITATION PERMIT <br /> ------------------------0_----------------------------- - Permit No.. 7-_7/y <br /> (Complete in Triplicate) <br /> ------- ---------- <br /> ?7 <br /> ----- Date kssued-.-.--.`- -__-._-.- <br /> ---------------......------------------------------------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District,for a "permit to construct an1.d insial.l the-work herein described. <br /> This application is made in compliance with County Ordinance No. 549 ane!"ex_istin' 12u1es'6nd? ul tions: <br /> i �+ w <br /> I JOB ADDRE=SS/!_OCATION-- i 1---- ,--./------- z ` TR --- <br /> E <br /> Owner's Nme.---- �! Phone <br /> a -------------------------------- - <br /> rr +�? -- --------- ; <br /> Address. `� ��r� _ ------------------- ----- <br /> r b... . j - --- ----- ---- ------- --------#--------- -. City--- ---- ------- --„- Z.ipp � y' <br /> Contractor's Name ! r ( ------ License # �C�` ---- Phone: 71 Z/ <br /> �= i -- a !�- Y '� a I <br /> -#. _�tel p - Other------- —-------=-------- -- - ----- 011 <br /> Installation,wilI serve: Residence Apartment House Commercial Trailer Court; a, <br /> ❑ i <br /> k 1 t <br /> Number of living units:_-- __Number of bedrooms----- _- --Garbage Grinde�r___�__Lot Size_-/ <br /> Water Supply: Public System and"name--------------------- ---- --'- ------ ------- _.---- --------- ---------------------------Private <br /> s_ <br /> Character of soil to a depth of 3 feet: - Sand ❑ Silt❑ Clay❑ 4 Peat;�� :Sandy Loam ❑: Clay Loam [� <br /> Hardpan E] 'Adobe ❑ Fill Material..----------If yes, type._i---------------i----------- <br /> s � r <br /> {Plot plan, showing 'size 01,16t, location of.system in relation to.wells, building S,'etc.'must be placed on reverse side.) <br /> NEW INSTALLATION: (No; se tic fi a -. _ 'pit - <br /> ' p ' - �p`g pit errriifted�if public sewer is available within 200 fee#,] <br /> PACKAGE TREATMENT ['] I SEPTIC TANK' ("'I <br /> je a e <br /> a} <br /> Site.... _ x " _Liquid Depth-. � <br /> e =No. Compartments--_.--CapacitY 1 <br /> ' <br /> Ile ; <br /> - - ------ <br /> .: Distance;to�nearest:INeLI�::��..�L�______________-__ __-__�oundat.ion_ *Prop:aLine � <br /> LEACHING LINE: [ ] No. of Lines i w• --- _--,-- Length of each line,.,-..:-a _`�' Total Length 7 - ---- - <br /> 'D' Box . ... : ...DepypN -_ th Filter Materia,-l-�. <br /> - �- _ --.. --. <br /> -Distance to <br /> nearest: .......Foundation-----!_0._- ____Property Line------- <br /> [ ] ------------------------- <br /> Dep <br /> ------,---______=_s_ <br /> Deph RotlFIIYse� <br /> No <br /> ...Y" Water Table'Depthlt = Rotk>ySize <br /> Distance to earest-.111:.. - ------ -Foundation -- ------------ -- Prop. Line �. <br /> n <br /> REPAIR/ADDITION (Prev. Sanitation”Permit#------`-' "°---------'-------------------=-- -----Da#e -- '-----------:-----1 <br /> Septic Tank (Specify Requirements)--.- ------- )--.------ ==-'------------- ------ = ------------------------------------ --------------- -------- - <br /> =' <br /> Disposal Field (Specify Re uirements) - � ' --j--- ----- <br /> ---;---.--- ---- --------- ---------- <br /> : <br /> ----------------------------------------- ---- --------------------- -------------------------------------- -- - �- <br /> I - <br /> --------------------- ------- -- --------------- f- :------=----- ---- <br /> " (Draw existing and required addition <br /> :on reve`sie side) <br /> I hereby certify that I have prepared this application and that-the 'work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the: San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> certify that in the performance of the work for which this permit is issued, I shall"noi employ any person in such manner as <br /> to become subject. to.-Workman's Compensation laws.of California." <br /> Signed MT <br /> - ------- ------ --- -- - --.-- ,... - <br /> . - Owner � <br /> BY ------ -T - -- . ------ ---- - - ------- 1 <br /> Title <br /> (if other than=owner) � - . ..- � - ' .n _,. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-'-' -- <br /> �///�/ -------------------=-------------------------------DATE--- -- �--------- <br /> DIVISION OF LAND NUMBER.. - ------- ------------- DATE. <br /> ADDITIONAL COMMENTS----------------- ------------------- ------=-------------= = = - <br /> ---•----------------------- ------------ -:------ --------------- :-TA <br /> --- --- - --_---- -----: - <br /> -------------------------------- --------------- ---- --------------- ---- ---- -- - ---- ------- -- <br /> R "'Final.Ins ection b - _:.. Date = ! iP Y = �`EH 13 2a SAN UIN LOCAL HEALTH ISTRICT F(&�5 21677 REV. 7(7d 3M <br /> �` <br />