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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. 7 �/.... <br /> .....�............ �. .�. ........ lCompleb in Triplicate) / <br /> . . ... .... . . This Permit Expires t Year brain Dam 11"yed Doh I::ued ../..: `, :75 <br /> ........... <br /> ,Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal) the work heroin <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rule: and Regulations <br /> JOB ADDRESSAOCATICNV .......� �f�....,/. e''f. ,3:' 'c�.cjlrf... .... lQ. �.. i3? / � TRACT .......................... <br /> Owner's Name ... .%C�.. f,�S.............................. .. ......... /� ..:................Phone .7.7:./., . ,. <br /> Address .........la.. 'Q. ,... 'I `. a ? ...:..............I............Citya <br /> ,17. <br /> � ..*............... <br /> Cotttraator's Nasr+a ... t✓"� .Wit.; c :... .-;;G !lt ..5 x 3. Phone 5 <br /> Installation will serve: Residence JVApartment Houso 0 Commordal❑Traller Caw 13 <br /> Motel 0 Other............................................ <br /> Number of living units:........ Number of bedrooms ..¢........Gcubo.go Grinder ............ Lot On ................ <br /> WaterSupply: Public System and name ............. ......... ............................_...................................................Prfvpla <br /> Character of sail to a depth of 3 foot: Sand E3 Slit Q Clay ❑ Peat Q Sandy loam-C3 Clay Leaat)d <br /> Hardpan 0 Adobe Q Fill Material ............If yes,type...........moi:.......... <br /> )Plot plan, showing size of lot, location of system In rotation to wells, buildings, etc. must be placed an reverse elde.l <br /> NIIW WMALLATIONi (No septic tank or seepage pit permitted if public sewer Is available w*&200 foot,) <br /> PACKAGE TREATMENT 17 SEPTIC TANKSin........ fa:.... ...... Liquid Clao ......V?.......,.. . <br /> Capacity ..A�40..I. Type per atm MaArssfad..�'a.�.ls: ,t¢-tib. Cornpartintertls .....4:........� <br /> Distance,to nearest: Well ....,/.: .4.'....................Foundation ....../..Q...'..... Lino....,� <br /> LEACHING LINE bQ No. of Lines ....4....... ... Length of each tote.... . ......I... Tour! ,Length ..�Z:f� ..... <br /> . . y .�. <br /> D Box .can ... Type filter MaMria) ..Depth Filter Mate►kt1 ..... . .'.............................. <br /> � <br /> Distance to nearest, Well 70......... Foundation ....../. ........ Property Lite ....9..�. .�. <br /> SEEPAGE PIT Depth ....fir ...:. Nurrt�ier ..... Rook Fli�l 'llirNt 0Q�j <br /> ...: ........... ..::��.... ... ... <br /> Water Table Depth .....caP..................................Rods Size ...1...., .. ....... <br /> Distance to nearest: Welt .......1-,S..562.:..............Foundatian .. .�..... prop. Line .....4..K...J <br /> RRPAIR/ADQITION(Prov. Sanitation Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) ...:.... I......... ...................... .. <br /> . ...... .... . ...... ........ ...................................................... o <br /> Disposal Field (Specify Requirements) ...---•......................... ........................... ....................................... ............ .. <br /> .... . <br /> ..........................................................Z <br /> ................•-................. ... --•---........... ............... ....... ......M.................................. <br /> ........... •-- ................................... ................... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that i have prepared this application and that the work will be done in ocerdmce with fess jmquh <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Load HeaNh,9horld. Meese *woer let Now <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I net employ any parse» in wdt Meww <br /> as to become o Workman's �pensatlon laws of California. <br /> Signed --------- •. . .. ..... ...... .............. <br /> --•-- •Aw+ger <br /> By ----------------- ` ``- •• . ....... Jitle ..........__..................... ...... .:.......................... <br /> (If other tha owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .,.- : _. ........................... . DATE .- .:. ...... <br /> BUILDING PERMIT ISSUED ....... ••. ......... ......---•-•.....................DATE .......-................................. <br /> ADDITIONAL COMMENTS ......_..... .................... <br /> ...----..............-•--....................---................................. ..............•........................ ........ ...... .................................................. <br /> ..............................................................................................-........................ - ......... --.........------ ---------............................ <br /> Final Inspection by: ., . ....... - u r�.----------"-••.............................. . ............................Dat- <br /> e <br /> ..���:� �`" ..................... <br /> EH 13 24 1-613 Rev. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />