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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT <br /> (Complete in Triplicate' Permit No. ....:�... ........ <br /> ...... ......:... ............." Date issued .�.'3..7.� <br /> ............................... This Permit Expires i Year From Dote Issued <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 Regulationss <br /> JOB ADDRESS/LOCATION V1111... -.C .< �_. .. .. .CENSUS TRACT ....___.......: <br /> .. .................. . ....... <br /> Owner's Name . . .. .........._. ..... l�? !.---... .. . .....Phone .. .. ... ,. <br /> Address ­, %,-C .....City . .�.. ............ ..................................... <br /> ... .... . ... <br /> Contractor's Name ....license # 1. ... Phone .............................. <br /> Installation will serve: Residence Apartment House Commercial QTrai{er Court 0 <br /> Motel ❑Other_:....... . ............................... <br /> Number of living units:.------ .. Number of bedrooms ._:;_.Garbage Grinder ............ Lot Size ....1�� ,. r -........ <br /> Water Supply: Public System and name ------ ......................................... ..............Private M__ <br /> Character of soil to a depth of 3 feet: Sand D Silt❑ Clay,0 Peat❑ Sandy Loom 0 Clay loam Q <br /> Hardpan 0 Adobe Qr Fill Material ............if yes,type............... ..........:. <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on rovers* side.) <br /> NEW INSTALLATION: (No septic tank or seeps pit permitted if ublic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK 17 ] Size it���. .� / <br /> ........... Uquid Depth .�r/................... <br /> Capacity Type � •��.. Materia{..,�°��.�. Na. Compartments -2rr-..............� <br /> Distance to nearest: Weil ......._.5s- ..........Foundation .... ... Prop. Line ....1161 . -�jl ..... <br /> LEACHING LINE [� No. of lines --..- ............. Length of each line-------4C/./...... Total Length .. <br /> 'D' Box ...../.... Type Filter Material Depth Filter Material ...../. .*............................... <br /> Distance to nearest: Well ....... fi .. Foundation -.... ..... Property Line ..... - .... �� <br /> SEEPAGE PIT [ Depth .., Diameter .....A7.5.` .� Number ..-.... ............... Rock Filled Yes 0---No O- <br /> Water Table Depth -------------zC-,&4 .................Rock Size ...Distance to to nearest: Well ._._..._, l' ...........Foundation ._. Prop. Ltns .... y <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...----- ................................... Date .--.--............................) <br /> v <br /> Septic Tank (Specify Requirements) ..........................•- ----.-.•- . <br /> Disposal Field (Specify Requirements) --------- ....... ..... .-rr✓ <br /> .. ....j ...f .. ... <br /> _ - <br /> --_--------- --- - X <br /> (Dr xistin and re wired addition on rave side) <br /> I hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin <br /> County-Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nom* owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------ Owner <br /> BY .... _ . Title ----------------------- ---------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APP_iCATtON ACCEPTED BY -- ------------------- - . .. . .. . --------. DATE <br /> . .- <br /> BUILDING PERMIT ISSUED .... •---------------- _DATE - -..... <br /> ADDITIONALCOMMENTS ................................................ .•--•---------•-------- ---- ------.........--...-:...._- ----------------- ..--•----_-----,-----._ <br /> --- ------ ..................... ........................ ---_-----------..... ------------- --------- - ..........--.------ ........... ............. <br /> _.. --------------- ---- ----------- ................... _... - ------ -----....._.._.........---....... <br /> ANOAQUIN <br /> Final Inspection b _� -Date I�... .42 __6.. <br /> ....... <br /> Eli 13 24 1-68 Rev. 5M LOCAL HEALTH DISTRICT 8/7)t 3M <br />