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` FOR OFFICE USt: <br /> -- APPLICATION FOR SANITATION PERMIT <br /> -. -----• <br /> F <br /> (Complete in Tripllcatel Permit No. ...................... <br /> This Permit Expires 1 Year From Dafa Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> i described. This application is mode In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> �r y <br /> JOB ADDRESS/LOCATION ....�..1._�5,3:-....�?�_- ......... ............................CENSUS TRACT' ....5...�9•.....: <br /> I Owner's Name .s-..._... .. N .........::N.E.W................................ <br /> ....... ..... . .......... ....__ ......... e <br /> Address ..._. .Jq�7-� ......... .. �7.._V--T.A«E....--•---- -•_.. City _....F.s��_L46W ' <br /> Contractor's Name .M.�..UO- �t . 5 PT�G..-?��RV. .��.L€cense # ............. Phone ... ......................... <br /> Installation will serve: Re ence -9-partm'ent House 0 Commercial :QTrailer Court 0 <br /> C►'tlle .............. ,. <br /> ...... <br /> I< <br /> Water Supply: Public System and <br /> of bedroo'i'ns .. .....Garb age Grinder ; Lot Size . � � '.�r' , <br /> Number of living.units:..... ._____ <br /> PP Y: Y d name Private <br /> Character of soil to a depth of 3 feet: Sand t[3 Clay ❑i Peau❑ Sandy Loam 0 Clayioam `�-- <br /> I Hardpan Adobe 0 Fill Material .........._- If yes,type .............-r"::.......... <br /> (Plot plan, showing size of lot, iocationt of s ` w <br /> tem In relation to ells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: (No septic tank or seeps pit permitted ifipublic sewer Is available within 200 feet,} <br /> PACKAGE TREATMENT [ SEPTIC�T/ANK3...... Liquid Depth ...... ...._.. _.. <br /> CapacitP/95p?�Type R. _aoy.Q. Material hM 017-No.. Compartments --- <br /> istanceLto nearest- Well � om <br /> t '' .Foundation .1b... ........... Prop. line . •• .• <br /> LEACHING LINE 1,[ No. o LiAes _._..!�..�..------ len th o 'each line.....7-5-'_.........: Total Length .....,l ......... <br /> D' Box ,�Type F€Iter Material l3-Q.--C . <br /> ; .Depth Filter Material ....11.17.1 � <br /> Oistanee o nearest, We{i..... ...__ '^.�Foundat€on ..L±�.. ........... Property Line { <br /> LS..�.. <br /> 4 <br /> SEEPAGE PIT . ! • 0 <br /> It <br /> } .......�.._.-P Number <br /> � �----Depth �� ...--r-Diameter- - � 'C2........ Rock Filled Yes ��o [ <br /> Water, Tdble Depths X f 0 # Rock Size <br /> - ......... <br /> ?,Distance/to nearest: Well �©Q -"t` �._ Foundat n .-/10 'y'-: Prop. Line ZVI <br /> REPAIR/ADDITION(PreW Saryitcition Permit# ................ Date <br /> �,f <br /> • ... <br /> Septic Tank (Specify Requirements) ..... ........ <br /> ...._ ..,�� �............................ <br /> ....._..._•--- <br /> Disposal Field (Specif� Requirements) .3. .. ......t?,1 ....' [..._.. ...........................-__.................... <br /> .............. <br /> . <br /> -..-. <br /> ................... ... ...... . t I <br /> . d-...._..._.....-� - •• • --- ._..__--_•..:......__....._-................................ <br /> _.._._._.._.__..__:......_.._...___...__...__....._........ <br /> (Draw existing"and required addition on reverse side) <br /> I hereby certify that I ho a prepared this application and that the�work will be done in accordance with San Joaquin <br /> County Ordinance`s, State[laws;tand#Rules'andi Regulations of the San Joaquin Local Health District. Home owner or iicen- <br /> sed age"th <br /> € s the following: itt! <br /> "I certif"once f the work for which this permit la iissued, i shall not employ any person In such manner <br /> as to beorkma Compensation laws of Caiiforni'�E)'Signed.. r ) . Owner <br /> �. ri -Q..... Title . <br /> SY `-....the v ............................... �� � ••............................ .•-........._... ..-=-----.......... <br /> I <br /> If other than owner � � <br /> FOR DEPARTMENT USE ONLY <br /> -APPLICATION ACCEPTED BY -E --...c...... ..... ....f i DATE ...... ...�.�7: ,� <br /> BUILDING PERMITfi ISSUED ...........................I.. r DATE <br /> =:.s... ;.................... ................. ............. <br /> ADDITIONAL COMMENTS ............ ............................ ....... ..._._.. :.__..._.......... <br /> t <br /> } <br /> .. ..._ . .. .. <br /> R744 <br /> Final Ins b . <br /> x�A .. -- -••�'. .. `.-'Date . ._ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F w 13 241_,An a_,, cis <br />