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FOR OFFICE USE: <br /> • APPLICATION WR SANITATION POW <br /> ....... ........ ............ <br /> 11compleft In Triplicate) permit Na <br /> .....................................I................... This remit Expires I Yew From D**Issued Date <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application is made In compliance with County Ordjnafjce No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ...... <br /> ......�_1_9...... ...... .....................CENSUS TIM= .................I........ <br /> Owner's Name ........ .................................. ............. .6�...... Phone ................................. <br /> Address ..................... . <br /> . .............. ....... City ............... <br /> . ....... ......... ............ <br /> Contractor's Name ....... osnse# <br /> Installation will serve: Residence rtftmt House![J Commercial oTrallor Cow r] <br /> Motel 0 Other..................................... <br /> a' b�,r7s - <br /> Number of living units:.._- ./... Number roams _3......Garbage Grinder &c..... Lot Size <br /> ......................... <br /> V <br /> Water Supply: Public System and name -.7 <br /> .. ... ....... <br /> .........................................Private 0 <br /> r <br /> Character of soil to a depth of 3 foot: Sand 0 Sit 0 Clay eat 0 §Cmdy Loom 0 Clay Loom 0 <br /> Hardpan 0 Adobe ff'Fill M6torlal,./W.. If Veto typo............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, otc, must be placed 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 f j size.......I............... ........................ Liquid Depth ..........................\Y <br /> Capacity ---------- ......... Type <br /> .................... Material-------------------- No. CAmpartme . .................. <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line .............:.......H <br /> .1 <br /> LEACHING LINE No. of Lin'es -------- _------------ Length of each line............................ Total Length <br /> V ............ <br /> ...........................V <br /> Box ....... .... Type Filter Material ....................Depth Filter Material ........................................... <br /> Distance to nearest: Well ........................ Foundation ......................... <br /> SEEPAGE PIT Depth --------------•--_-•I Diameter .. Property Line ....................... <br /> Water Table Depth ...._ .............. Number ............ ............... Rock Filled Yes ❑ No <br /> ------------ -----------------------------Rock Size ................................ <br /> fi <br /> Distance to nearest. Well .......................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) .......... ......... ...................................... <br /> -,00 Drs sal Field (Specify Requirements ............. ....ge. . . ............ <br /> ................... ? .......... ........................................... <br /> ... . ................................................................................................................................................. <br /> .................................... ....... ........................................-.......................................................................................................... <br /> .(Draw existing and required addition on reverse side) <br /> I hereby codify that I have prepared this application and that 60 work WIN be done in accordance with San Jo"Wa <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home *"or or liken. <br /> sed agents signature certifies the following: <br /> "I Codify that in the performance of the work for which this p*nnIt is issued, I 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 ...... --------------- <br /> ............. Title .... <br /> ------- ----- -- --- - ---- --------------- <br /> V er than owned ............. <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... <br /> ........ ........................ --------- ........ DATE ..... ...... <br /> BUILDING PERMIT ISSUED ............... .. ... .. ... ............................................ ..............................._DATE ....... ................................ <br /> ADDITIONAL COMMENTS <br /> EH -- ---------- -------------­------- <br /> --.--.-..-......... <br /> ......................... <br /> ,............. <br /> .......-.-._....­ ­-- - ..... - - . ...-.-.._......-._........-.-.-..-...-...--..-.-..............-.-.-.-.-.-.--..-........................... <br /> .... ..... ...... . . ...........­..­..­...1.-.-.-..--.-.-.-.-. ...................•---.............._.. <br /> ........................... ........... <br /> ...._ ... . ... . .... ..... -------__..... . . ...... ...........Final Inspection by: .. .. .......Date ... <br /> 13 2 1-68 Revs . <br /> .................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />