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FOR OFFICE USE- <br /> ........ <br /> APPLICATION ICOR SANITATION PERMIT S^7 <br /> (Complete In Triplicate) Permit No. 7 ....1... ... <br /> �. <br /> ........................................•-•. <br /> Date Is v2S-�� <br /> .•.......... This Permit Expires f Year from Date Issued sued ...................• <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 Regulations: <br /> JOB ADDRESS/LOCATION ?/ . .-- •-__-- -___-- - - ........... <br /> Owner's-Name <br /> Phone ... ... <br /> Address _.. f�W ...., City .. ................... .. <br /> .......a '= I..................... License i,..2Y. J- _ � ..e4 _..- <br /> Contractor's Name - ------ -- . • Phone ..... e404 <br /> - <br /> Contractor's <br /> will. serve: Residence Apartment House 0 Commercial E]Troller Court ❑ <br /> Mote)0 Other----•- ---•-••••........... <br /> Number of living. units:..._..... Number of bedrooms ......5...Garba_ge Grinder ...._....... Lot Size ............................................ <br /> Water Supply: Public System and name <br /> pP Y� Y ----..........................................................................................................Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑. Clay Loam ❑ <br /> Hardpan❑ Adobe 0 Fill Mater€al ............ If yes,type ............... ............ <br /> )Plot plan, showing sire of•loft, location of system In relation to wells, buildings, etc. 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 I ] SEPTIC TANK 3 <br /> Size................................................ Liquid Depth <br /> Capacity --------•-----•---•- Type --• --..... ' ---- Material..• • ........... No. Compartments _...._ ....._........ V� <br /> �-►� I Distance to nearest: Well ....................................Foundation ...................... Prop. Line .....................s <br /> r <br /> 1 No. ofLines_...._..._ <br /> LEACHIi�fG�NE [ l , . .-----•--:I-.--. Length of each line............................. Total Length ............................ <br /> 'D' Bax Type Filter Material ....................Depth Filter Material ......,.._................................... <br /> Distance to nearest: Well .......... ------- Foundation _............ ......... Property Line ............._,......... <br /> i <br /> SEEPAGE PIT O I Depth ---------. .. _---- Diameter ---------------- Number ..........._..._............ Rock Filled Yes ❑ No O <br /> ► Water Table Depth •• -•-•••• ................Rock Size .---------.............. ... <br /> Distaice to nearest: Well .___.... ._:. ..Foundation ........ Prop. Line <br /> ......... .............. ...................... <br /> w <br /> REPAIR/ADDITION(Prev.;Sanitation Permit�# ...........................................�Date .................................. <br /> Septic Tank (Specify Requirements) ........................................................••-•- <br /> :.._....... <br /> Disposal Field (Specify Requirements)yQL.. �y :.... <br /> .........................17 - i - - i - - -'I---" !J � ­­......................I........? <br /> •----------------------------•---- ------------------------•---•--- -----------------------------------............. ---•----.._..•---•--•-----••-•-•-•--•-•-•--....--•--•............................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that Ch va o prepared this op011catlon and that the work will 'be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San.Joaquin Loiat Health.District. Home 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 ,a I= '�'; �} Title -------------- r <br /> (if of than owner) , <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY --- - --- -C»aa -:------•-----•----- Zt7.- . <br /> -- -----------------•--•--.....,, DATE ._..----�=----•---.._... ---_._..------=.� <br /> BUILDINO PERMIT ISSUED ............. - ----- -- ---•-------- -------DATE .......................................... <br /> ADDITIONAL COMMENTS ---------_-------- <br /> ----------- ... <br /> •-------•--• ------------------------------------------- •-------------- ..------- ....................... ...... <br /> - - <br /> Final Inspection b : ..---------•----.. _ _ �__� ......................... ..... .........•----- .........Date 1."!�.--- .'. _ ----_-----_- <br /> Ell <br /> Ell 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M <br />