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- ., <br /> FOR OFFICE USE: APPLICATION FOR SWNIT TION PERMIT <br /> --------- ----------------------------------------------- � Permit No: <br /> (Compltte in Triplicate) <br /> - This Permit Expires 1 Year From Date Issued Date Issued --:2-2-23 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to const t'and instatl'fhe worVherein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules bn-d,Reg61btions! <br /> JOB ADDRESS/LOCATION ----1 ,� - -------- ------------K--------Ra tJ f CENSUS TRACT ---------r �C�.... <br /> Owner's Name ------- ��-ti --------------------------------------------------------- <br /> ---------------------- <br /> _ -----------------•----�----I - -----Phone -- <br /> �a ----------- ---------------- <br /> - . -- �-�-�=- � -- <br /> Address ----------------� CitYF `�' <br /> 1 <br /> Contractor's Name ©iu ��--------------------------------------------------- <br /> - - -- -- -- - -- - -- -License# ----`----,--�-- .�`j----- Phone ---------------------•-------- <br /> Installation will serve: Residence ❑Apartmer ifi Ho"use;-[ .Co`mmerci lI :flTraile I �i�­ <br /> L�:Imotel ❑Other ------ -------------- -- ----} I f <br /> Number of living units------- _____ Number of bedrooms _____Garbage Grinder`_ _._ Lot Size <br /> Water Supply: Public System and name -- ---- -----------------------------.-------:_:-------------------- Private <br /> _._..- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ . Peat 0 f Sandy Loam LCIay-Loam :❑ <br /> Hardpan ❑ Adobe'❑ Fill Material _. _____ If yes,type ____________________________ <br /> i t <br /> (Plot plan, showing size of lot, location of system in relation to wells, lauildi.ngs, etc. rriust be placed on reverse side.) <br /> i ; 3 <br /> NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,! <br /> PACKAGE TREATM, NT_[_3F_SEPTIC TANK'[< Size :_ _l ;__ _-__.-_�%_ _ Liquid Depth _. ----________,___• r <br /> Capacity --------------------C� Type __n aterial__C� C _I o. Compartments --------- ----___...- <br /> 9 - rstance to, ____________Foundation _..1.__________-:___ Prop. Line __.ry`.�__..._._...-.... pp <br /> LEACHING LINE [ No. of Line's __._ `^A ' length o� eacfi.il,iiie-'._._ .______�_.___.__ Total` Length _____ ... �___....._. <br /> r VrL / ' f f <br /> ` --�-'D'-Box-__ 5_ Type Filter Nl6te�ial—___ _ -.Depth, Filter Material ____!_ <br /> _ f <br /> - ---� ' e . <br /> Distance to nearest: Well __. _______________ Foundation ___� __-"-'f_ Property__Line -fes_._ TV <br /> SEEPAGE PIT Depth -- --- Diameter __ '� .- Number- ------_`�.-___ _ _ <br /> [ -X �__-_ y Rock Filled jYes �No`❑ <br /> Water Table De )P <br /> pth' ______________ t Rock Size ___ <br /> - <br /> -- --- r �- - .. �. — y. <br /> �- <br /> Distance to nearest: Well --------� ------------------------Foundation ---- --------- PYop. Line _.__. ........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) '1 <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------•------------•--------- --------•--------- ---------------------------- <br /> ------------- --'. <br /> Disposal Field (Specify Requirements) --------- ---------------------------------------------------- -----------------•---...---------� <br /> I �,.� �__ a -----------------„---- -.._- <br /> r.-_- <br /> -------------`------------ ----- ' '� '- -------- ( _ ='`i«.x `------------------ ------------------------------- <br /> s (Draw existing and required addition on reverse s'ik` f <br /> I hereby certify that I have prepared this application and that the work ;vill be done in: accordance withSan Joaquin <br /> County Qrdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- <br /> sed agents sign re certifies th Ilot' rk <br /> C <br /> ` "I certify) the performs ce• @tfor which this permit is issued,.) sha11not employ any person in such manner <br /> as to bec )ectto Work 's Cti.on laws of California." <br /> Signed = I : --------- ------ Owner <br /> ------- -------------------------------- <br /> By "---------------------` d-------------------------- <br /> ---.-------------------- -Q---- Title ----------------- <br /> (If-other than owner) <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .---�--R `" ----------------------------------------------------------------------------. DATE ------- -- <br /> t-. i <br /> BUILDING PERMIT ISSUED -- ------------- - -------- -------- ---DATE -------------------- --------------------- <br /> ADDITIONALCOMMENTS --------------- - --------------------------------- -- ---------------------------------------'---------------------------------=--------------------------- <br /> _______________________ _____-------_---- _ _ _________ __________ ______ ____ _ _ ________________._____________________.___-.-_--- ._________ <br /> - ti <br /> - <br /> +r ___ ------------------------- <br /> Date <br /> ___ _ .__ __ �_•��-. J!� _ <br /> Final Inspection b E --------------------- <br /> SAN <br /> - - Date //_. . :_ � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />