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FOR OFFICE USE: =' --- <br /> -#� <br /> APPLICATION'FOR`SAWATIOiV"PERMIT .7 <br /> ....................................................... IComplah iat Yripiicate) Permit No. ............... . . <br /> ;. ...:.... .�+��. Date Issued :"F•��.. .� <br /> ................. ........ .. This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construe! and Install the work hweln <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, �I <br /> JOB ADDRESS/L ON ..... .. .5.'!�...,. _. r.............................CENSUS TRACT ........................... <br /> Owner's Name d? _.. ...... .`.. .............. ....•....... .......... ............Phone ............................... <br /> ..... <br /> Address ... .�� �:.../ .. -._....._..City . _..... _ ... <br /> Contractor's Name . � f_ ._ ......................................Ucense .. ..ca Ahons ; ' <br /> Installation will serve: Res deZ Apartment House C3 Commercial[]Troller Court ❑ <br /> Motel ❑Other <br /> Number of living units=......------ Number of bedrooms 5......Garbage Grinder ------------ Lot Size ............................. <br /> ---•-- ...•-- <br /> Water Supply= Public System and name ...............................----....................---------_......----------._.........-........_._...Privaro <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam ❑ <br /> Hardpan❑ Adobe❑ Fill Material ............If yes,type ' <br /> )Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse. <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 204 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK( ] Size...... ......................................... Liquid Depth ...----.-_................ <br /> i f .........� { <br /> Capacity 1 ..... Type .. aterlal........:............. No. Compartments .. ! <br /> 1 <br /> Distance to nearest: Well _._,f/�Q __Foundation __ e...............Prop. line . <br /> LEACHING UNE [ ) No. of Lines -- ---------------- Length of each ine..�1�........:._......_ Tata! Length .. :1.��...�..._ ' <br /> D Box .1--------- Type Fitter Material Depth Filter Materia! .............................._..... <br /> • , Distance to nearest: Well ........................ oundation --------------..-.--_... Property Line ................... j <br /> w { ] p ._ Rock Filled Yes ❑ No Q <br />. <br /> SEEPAGE PIT Depth ---.---•------...... Diameter ---------------- Number -..--..........----....._. I <br /> Water Table Depth -- .----Rack Size ` <br /> Distance to nearest= Well .......................................Foundation .................... Prop. Line ............. -.. <br /> REPAIR/ADDITION[Prev. Sanitation Permit# .................... Date ) <br /> Septic Wank )Specify'Requirements) .................................•--.--.. ................... ............................................ ......................... <br /> ' <br /> Disposal Field {Specify Requirements) ................................................................................................................:.................. <br /> .. <br /> •.............................................•--•-•--------------•------------------.......--.........-•--••---•-•-•--•-•-••----•-----•--•-••-•---....----•--••-.................... . ................ <br /> -- -----....................•----•---•-----•-------•..._._..._...----...........................-----......._......... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify than 1,have prepared this application and that the work will be done In accordence with San.Joagwn <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome owner or Ilsen- <br /> sed agents 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 <br /> as to bee V_msubect to Workman's Compensation laws of California.°' <br /> Signed ...: :... -.... -•................................. Owner ..p <br /> (If other than owner) <br /> OR DLPMNVYj USE ONLY <br /> APPLICATION ACCEPTED BY..---- ~' <br /> BUiLDING PERMIT ISSUED .....__.............. -.. ._ DATE -.-....................... .. <br /> ` ADDITIONAL COMMENTS ...................................................................:........... <br /> .................................. <br /> 4. .................................................. _............._....i........ ..............-- ......._..........................__....frJ[/J.f�..................... <br /> 1 ....................................•'""..... .. _.._...._. _. _....... .. ._ ........._._._............_..-......... V.! / <br /> Final tnspettion by: ..._....... ..............................Date .. ._. ///.:...._...._. <br /> EH 13 2b 2-6tj Rev. !1 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />