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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 7 (Complete in Triplicate) Permit .-- <br /> ------------ <br /> '"� t Date Issued_ <br /> ----------- --- - ------------------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Loca# Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA > ir <br /> r� ... - CENSUS TRACT <br /> Owner's Name Phone.'667 2— <br /> y g <br /> Address--- -- - F.0-' S�.- h City ------ -- ziP � <br /> Contractor's Name. - - ----*- ------------------License # J `3Y� Phone- �� ra -7 <br /> Installation will serve: Residence $ Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other.... - -- --- <br /> Number of living units: __ )_____---.Number of bedrooms----Y .Garbage Grinder___________ Lot Size-...i.. —7 310-_-- <br /> Water Supply: Public System and name..---------- ---------------Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 1KFill Material__ ____ _ If yes, type _ ___ -- <br /> (Plot <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pEaced 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 Size____ _ . ._ <br /> rx-�-'---- -- Liquid Depth. <br /> �� <br /> Type --------- -. - Material No. Compartments ------- <br /> Capacity-/6-00,. -; <br /> Distance to nearest: Well ___fd0 ------ ------ --------Foundation-----14 r. .. .. Prop. Line f�-------.----- <br /> LEACHING LINE No. of Lines . `__ - �,� <br /> ------_--.Length of each line .................... ----- Total Length --/ 70-1*-------- --- ------ <br /> jf <br /> 'D' Box..._ .Type Filter Material 4491rk Depth Filter Material---/10_---------------------- ---- <br /> .--_-__. <br /> Distance to nearest: Well--- _r'F_ --_.--Foundation____ _ �__f"-._....---Property Line �� <br /> _ - ------- <br /> SEEPAGE PIT j�Q Depth 2� Diameter.- fr ❑ <br /> p - •��_ -- - Number..--__-_� _ Rock Filled Yes [� No <br /> Water Table Depth---------- -- -- --- - - ------------- Rock Size- � �� ---- - - ------- w <br /> � <br /> - Distance to nearest: Well ___�� _' ------------____ ___Foundation..----10 ")_____ Prop. Line <br /> REPAIR/ADDITION (Prev. Sanitation Permit#. - ---_---- ---------------- - _ --- Date --------------- - <br /> Septic Tank (Specify Requirements)-- ------ - ---- --- --- -------------- -- --- --- - ----------- <br /> -------------- <br /> Disposal Field (Specify Requirements)----- -------- <br /> ---------- -------------- <br /> ----------­ ---- -- ----------- <br /> (Draw existing and required addition on reverse 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 /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed-- . - --- Owner <br /> 0or <br /> f. <br /> By.. 1 ---- ---Title ..--- <br /> f other than owner) <br /> R EPART ENT W )NLY <br /> APPLICATION ACCEPTED BY - f -- DATE <br /> - - <br /> DIVISION OF LAND NUMBER.---....-. - --___--- - ..----- -----DATE---------. <br /> ADDITIONAL C M ENTS.--- <br /> ------------ <br /> -------------- ------ --- <br /> Final Inspection by - - ---- ----------------------EA­'L_ <br /> --------- - - Date. ---�' 7- --g----- - ------ --- <br /> QU <br /> EH 13 24 SAN JOAIN LOCAL WTW DISTRICT rss 2P6" REV. 7/76 3rn <br />