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.wn vrrrL,C 'J."r - ..r. <br /> APPLICATION ICOR SANITATION PERMIT <br /> .................... <br /> ,-----••.......................... . (Canpleteln Trlplfcata) Permit No. .._.�:�:�.-.. <br /> 'Y' This Permlt Expi is es I Year From Date Issued Date Issuedox.: <br /> Ap catioh is hereby made to the San Joaquin Local Health District for a permit -to <br /> described. This application is a e n c mpliance with County Ordinance No. 549 and existing <br /> Rules and and Regulations:sin <br /> JOB ADDRESS/LOCA N .... <br /> - ...._. ....._..Iz7 7 <br /> Owner's Name ( " ..... ..CENSUS TRACT .........._ <br /> . .�. ._.. <br /> Address ......... <br /> I..................................... <br /> .............. Phone <br /> Contractor's Name ------------- ....._.----- ............. ••--•--. City <br /> .......................................................... ................ <br /> _ <br /> •4.eev''Ie-----------•----•----------- --• ------ ----------License # ---------• <br /> Installation will serve: - - - - ------------- Phone .-•-------••-----.....--_-- <br /> Residence[Apartment House❑ Commercial.❑Traller Court <br /> Motel ❑Other.......................................... <br /> Number of living units:_---- _ -- <br /> g ,1.-- Number of edrooms ._�. <br /> ---- ----Garbage Grinder---------1_ Lot Size .-_-- ----_-•--• -- _ <br /> Water Supplyf Public System Y and name .-__._ ��•---• <br /> Character of soil to a depth of 3 feet: Sand❑ Silt[] Clay Peat .... .. ...... .......... ..... •---..Private 0 <br /> ,� ❑ Sandy Loom t] Clay loam <br /> Hardpan[) Adobe❑ Fill Material ............ Ifes <br /> Y ,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> NEW INSTALLATION; buildings, etc, must be plated on reverse side.) <br /> INo septic tank or seepage pit permitted if public sewer is-available wi 200 feet <br /> PACKAGE TREATMENT { ] SEPTIC TANKSize...... d ') <br /> � � f � Y <br /> ---•• --. _._ -•----�---�`�x""� i u d Depth <br /> ----- <br /> Ca acit ��OD .................. <br /> P Y TYPe�- ._�?.�YL'.--- Materiai.•�-•------ -----_ No Compartments <br /> Distance to nearest. Well /y, ......---Foundation"-- !�R .. <br /> LEACHING LINE - ..... Prop. Line .��..--.....' f <br /> [ ] No, of Lines _._..._, ----=-------- L,ength of each line.... ??f..$....___..J6tal`Length 1� ' <br /> `D' Box ��.�',�,' ��[' <br /> --- Type Filter Material ! I -Depth Filter Material �. - !r <br /> E � - <br /> Distance to n .............. <br /> sorest: Well .._..----_. ... .-_ Foundation Pro <br /> SEEPAGE { party line <br /> E PIT { ). De th ....................�nl ' <br /> ---�--- P ...... Diameter Diameter ��.-. Number .._.... .._.. <br /> f '-' ..-..-t. Rock Filled Yes �-- No <br /> Water Table Depth ----------_S. _.- <br /> ....................•-Rock Size ......... <br /> �Distance to nearest: Well ......��'G?-1Y-: '° <br /> '�'-•-_:-.,Foundation <br /> ;.._ p. Lina <br /> REPAIRt '" `--- <br /> ADDITION(Prev.(FraSanitption Permit� .__.............._ i�--- ro -•-• -•-----•---••_-- <br /> ......:....... Date ........ ! <br /> Septic Tank (Specify Requirements) ........................................... ........... <br /> :.. ..... <br /> Disposal Field (Specify Requirements) ......................... <br /> • _---------•----------------- •- ----- <br /> Draw existing and required addition on reverse side) ............ ................................. <br /> -'I hereby certify that 1 have.prepared this apptiratiott•.and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- <br /> sed agents signature certifies the following: k 1 <br /> "I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner 9{ <br /> as to becou ct to orkma 's Compsatio s Cafifarnia." <br /> Signed-- -- _ <br /> -• -- ---- - ••----• ---._ Owner <br /> (if other than!"ownerl <br /> -----•----------------------------- --•--- Title ---•-- = <br /> ~' OR ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --. <br /> BUILDING PERMIT ISSUED ...___ .......--- � <br /> --------------- ------•--_... DATI . <br /> ----- <br /> ADDITIONAL COMMENTS -- . ------------------ <br /> ----- -- DATE _... .... <br /> ---• . ...............------------------------ ..._. <br /> ................... <br /> Final Ins ection b ----......... """""'' <br /> -- . . . <br /> ---- <br /> --7 <br /> EH 13 2h 1-6f3 Rev. SM <br /> Date �'z- �. _------ -- <br /> SAN JOAQUIN CAL HEALTH DISTRICT �/7h 3M � <br />