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r FOR OFFICE USE; FOR-OFFICE USE: <br /> N i <br /> = : APPLICATION FOR SANITATION-PERMIT 4 <br /> --------��' ---------------------------- 'j <br /> (Complete in Triplicate) Permit No-- <br /> � Date Issued... <br /> _____.__. This Permit Expires 1 Year From Date,lssued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to-construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Reguiations: � <br /> } <br /> JOB..AD.DRESS/LOCATIO .. . _ �lI � ----.CENS,U,STRACT--- <br /> = _p <br /> Owner's Name----------- eT----.6VS4C,-1--------- Phone--- <br /> Address--- --------------=---------------- --- -----------------------------------'-- ---r-------------------- ----- City-- $Ct Z. :--------------Zip --------------- <br /> Contractor's Name ,�L„5O.?'.l..__` x �lKhQ --License # e _' 1�ne 1 <br /> Installation will serve: Residence', Apartment House ❑ Commercial ❑ -Trailer=Court ❑ ` <br /> k <br /> Motel ❑ Other------------ --------- -------------- <br /> Numbe'r.of living units:__,. --__-_Number of bedrooms-------Garbage Grinder_- -Lot Size__ , !r ---------------------------- <br /> Water Supply: Public System and name------------------------------------------------------------------ _________________Private <br /> f. p ❑ ❑ y 0 ❑ y.. .;.... � y l� <br /> Character of`soil to=a�de th of 3 feet: : Sand Silt Clay Peat Sand Loam Clay Loam <br /> Hardpan 0'­ Adobe ❑ Fill Material :.__i ._xdf yes, type---'------ -- <br /> (Plot plan;-showing size of lot,location of'system in relation-to'wells, buildings, etc. must be placed on reverse side.) <br /> . ti <br /> NEW-INSTALLATION': (No 'septic fank-or'seepage pit permitted if public sewer is available within X00 feet,) Q <br /> PACKAGE TREATMENT [ ] SEPTIC TANi�,,,,[ '] Size-----.-�_�-U�-----VIRI �C.._&xic-x-`-S "Lic lid Depth--�}-------------- <br /> , �� --T `+ 11�1. t9�, Type a.. <br /> y ,GMater gal ,� e f No. Compartments-__ ------------------------- <br /> Capacity <br /> Z , Distan-ce:� nearest: Well.--_�i � "* ----------Foundati n -- -- _ p--=:---=---�--- <br /> �Q ___ ___. ___.Prop. Line__ _ <br /> {,.LEACHING LINE�.[.,.],.,,._„No.of.Lines.�_�.--------__._____.Len.gth of eachrline.___� �------.Total Length - ---------------------------------- <br /> .'D' <br /> - -------------- <br /> rK <br /> .D' Box__' Filter Material! _k Qepth Filter Material---�—- --------------------------------------------- <br /> V4 <br /> _______ ___ 4 <br /> ` -. <br /> r , o� unDistanceto neaN11I .- -- Property Line �__Jt <br /> d % n , <br /> Aev <br /> SEEPAGE''%RIT [ ] Depth_ '_____Diameter X�d Vu :17Z-----------____ Rock Filled Yes No EIC <br /> ~ Water Table-Depth--- ------------ --- Rock Size: ------- <br /> Distance to nearest: Well----- -----------------"` ____._--Foundation__.=--I---------------Prop. Line__ 2c---------- <br /> /ADDITION"(Prev Sanitation Permit#-- -------------------=-------------------- ------Date_----------------------------------.---------- <br /> '.REPAIR <br /> Septic Tank (Specify.Requirements) -� -----------------------------------------------_------ <br /> ------------- --------------- <br /> Disposal Field.(Specify Requirements -----------------------�� -- --------- ---------------------- <br /> ------------------------ - f yrs <br /> ------------------------- ----------=-- - ' <br /> �Ihaive <br /> (Draw existing and required addition'on reverse side)I hereby certify•thprepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances,:Stat Law and Rules and Regulations of the San Joaquin Local.Health District. Home owner or licensed agents <br /> �._ <br /> signature_certifies•the following: <br /> v : <br /> "I certify that in the performance of the work for which this'permit is issued, I shall not'employ any person in such manner as <br /> F. <br /> to become subject o Workman's Compensation laws of. California.". <br /> :. 3 -- ----------- --'------OwnerSigned---------- � Title. <br /> C �` oBy-------------------- ---------------------- <br /> s <br /> , <br /> (if other than owner) _ <br /> FOR DEPARTMENT USE ONLY ------------------- <br /> .I <br /> APPLICATION ACCEPTED BY_.___ ----- - -------- ------------------------------------------------DATE ------ y---- -`--�- <br /> .7y <br /> - -DIVISION OF LAND NUMBER-------------------------- ---- ------------ - <br /> - --I--------------------------- ----------------------------DATE-:--- ---------------- --- ---------- <br /> ADDITIONALCOMMENTS------------ ------- - -------------------- ------ ----------------------------------- ----- <br /> -------- --------------------------------------- <br /> --------------------- -------------------------- -------------------------------------------- --- ----------------- ------------------------- <br /> -------------------------------- <br /> - <br /> r - -------------------- <br /> -------------------------- -- �y ------------------------------------------------ ---------------------------------_------------------------------- ------------- <br /> Final Inspection b ---= - -- ------------ D 7J �ri <br /> - - - ate •- - <br /> EH 13 24 JOAQUIN LOCA HEAL-TH DISTRICT r R F&s �� 6 3M <br /> J 1 S <br />