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FOR OFFICE USE- <br /> APPLICATION................. APPLICATION FOR SANITATION PERMIT Permit No. 7 s� ' <br /> (Complete in Triplicate) - <br /> r ......................... Date Issued <br /> ._. .. ..r�_d...................•---..... <br /> This Permit Expires ] Y ar From Date Issued <br /> Application is hereby made to them J dquin ca at �stnct r a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rwes an Regulations: s <br /> /� <br /> I <br /> JOB ADDRESS/LOCATION .. „l . /-I�. .. ¢.In��r[ � ...l��i '<..c�1 .. �'..� C�NSUS TRACT ...................: . <br /> � ....... -- ............................. <br /> Owner's Name _---..... ��1f. t.J..40.--••---- 1.. ... ?.! . ...., Phone <br /> E +a7i <br /> Zf- <br /> Address ----- .... -u t <br /> ......... C .......__�...�_._..__._'.�.._.....---. �..J....`....`.�...... .�...�.. <br /> .....License Phonetor's Nome'...Contrac <br /> Installation <br /> will serve: Residence Cy<partment House Commercial [)Trailer Court 0 <br /> Motel ❑Other . <br /> Number,pf_li_ving units:...... Number of.b oo. . _-_....Gar .age_Grind e __ Lot Size ..7. °� -3•.. •.---• <br /> Water Supply: Public System and name ---.-- ��.��. --- -•-•- ftTlTr. f...........:.........................Private ❑ <br /> Character of soil-to a depth of-3 feet: Sand 0- . Silt 0 Clay"❑ Peat❑ Sandy Loam 0 Clay Loam 0 � <br /> Hardpan ❑ AdobeMI.-fill Material I�Iv _. If yes,type ............................ <br /> (Plot plan, showing size ofl)ot, 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 publicsewer is available within 200 feet,) <br /> - a <br /> PACKAGE TREATMENT [ SEPTIC TANK{g,]� ire...�j�, X. ........-•---•--.._...- Liquid Depth .._. _- ?'---_-.•-•- <br /> Capacity _h�.�__._.. Type ._ Materia .' �,C No. Compartments .�......... <br /> Distance to nearest: Well _..,,A.��..................Foundation .. 4_-------- Prop. Line . <br /> .. _ .... � <br /> LEACHING�LINE' � No. of Lines .....v�-�..._._•---- Length of ach line-_ _ ......... Total Length ................. <br /> 'ID' Box 1 4J.. Type Filter Material _....Depth Filter Material <br /> r ,p rtY l <br /> ` [ Distanc <br /> to neatest: Weil:_�/-?-....... Foundation .... ..Q___ Pro a Line ................. <br /> SEEPAGE PIT [i, Depth .... Dianieter !r=... Number ...... Rock Filled Yes No i❑ <br /> A <br /> Water Table Depth ..__.. ..Rock Size le i!' .........._ <br /> Distance to nearest: Well .........2. ...............Foundation .. o......... Prop. Line .,�.............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit ` <br /> ............................................ Date ................,.....-...... <br /> Septic Tank (Specify Requirements) .....................___....•-----•------------------------•----- •-•-•-w_------... ......................1..........•------------------ <br /> Disposal Field, (Specify =Requirements) ` <br /> ----------------------------------------------- ......................... ........................._._____-•-.................................. ...........__...-----------..........-•-........... <br /> _.____...'....................................................................................................._.___._........___.................__............__...._-._-.__-_--------..-.__--..._..... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the workF will be done inf accordance with San Joaquin <br />'F County Ordinances,,State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> i "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 become subject to Workman's Compensation laws of California." <br /> Signed --- - --_------ Own <br /> l -- 7 <br /> By ....... ------------------ .. _..._. �,------------------------------------• Tltle _ �.._... .. .-•-..... <br /> (If tan owner) <br /> FOR DEPARTMENT USE ObILY <br /> APPLICATION ACCEPTED BY--.T •• -..---•• .. . ----- - QQ'ATE -....._ _ .. ......7--- --..... <br /> BUILDINGPERMIT ISSUED ........---•---------------_------._......... ........................... ..............._CilATE ........................................... <br /> ADDITIONALCOMMENTS -----------------------------•-------...-•-•-----....:..._-----------..-_._:.._._...._........-----•------ <br /> -----_---.-----•- ---•---------------------------------------••---....................................--•--------..........._.._••. ----- -----------------------------------------....----- <br /> ---•...... .................�_ _ ... ............................... .................-._.:........... ---•--.. ........................ <br /> .._._.............................. :...... ... - ------------------------... •...... <br /> ... <br /> Final Inspection by: 3a •. ;�.............................. ...........Date <br /> lT <br /> _- SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7172 3 ME. H.13 241_'68 Rev. 5M , <br />