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f=//!V /3d <. W, .0 ■ <br /> FOR OFFICE USE: <br /> !6r APPLICATION FORSANITATION PERMIT <br /> ------------------=' ------------ <br /> - ------ [Complete in Triplicate) Permit No. <br /> ........------ ------------- ------------------------- -2---7-6 <br /> � <br /> --._-.._.._--._---------------------__----------- `� This Permit Expires 1 Year From Date Issued <br /> 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 /> desc 7-Tisga plication-i's''rhade in compliance-with,County-Ordinance•Na,-549 and existing-Rules and. Regulations: <br /> :,=JOB ;ADDRESS/LOCATI N -------------6Y--------------- --- ---------LIhI Q( __CENSUS TRACT ._...- ----------------- <br /> ATOwner's Name <br /> __Rho ----------------------- ........ <br /> Address .�. t �i� % p� <br /> = ------------------------------ �I-t <br /> t €' Ci Y -------- ---------------------- -----•-- <br /> 3 <br /> Cont'ractor's Name ..? 1 t1. I_PS C�hIST` C¢-`---------------------- --------License # -fZZ� - Phone --_-------------------=._...--- <br /> Installation wilt serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Court 1❑ t <br /> Motel ❑ Other ---------- j s <br /> Number of living units:-....t -___ Number of bedrooms -3_-.-.__Garbage Grinder ��---- Lot Size 10(5 1X 10©._._-.- <br /> J y� ---------- <br /> Water Supply:1 Public System and name -_ I t ±-! _ __ !_'rr-_--WaT) P--- ---- ' <br /> LRC�I : +.....Private E] <br /> Character of soil to a depth of 3 feet: Sand[] Silt❑�LL Clay ❑ Peat❑ Sandy Loam [ Clay.�oam :] _y <br /> I Hardpan ❑ Adobe.(] Fill Material Na if yes,type .-.---_ <br /> e - ------ <br /> (Plot`,plan, showing'size�of lot, 'location ofti system in relation to wefts buildings, 'etc.., must_be placed on reverse 'side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is p a lable within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK'P! <br /> Liquid Depth ---�--��----- <br /> Capacity /2-00------ Type pAgft-e'!^r_f>. Maferial_�0#VC�r: i No. Compartments --_.--Z--�: <br /> i D' ante to nearest: _Well ___-6,- --....._._.-_4-----_Foundation - ------------ <br /> -------- Prop. Line ._..-. <br /> --- <br /> LEACHING LINE [ No. of Lines -----�------------- Length of ea chlline______. � ` --- Total Length -----Asd_-----_.-- <br /> TypFilter Material �QDprth Filter,,Material - - rt------------------------------------- <br /> N1 <br /> LineDistanearestWell - Foundation <br /> Foun at oe --- Propey <br /> :... <br /> SEEPAGE PIT [ ] Depth ------ Diameter- ---------------- Number ------------------------___ Rock IFiliW Yes ElNo aj <br /> ( Water Table ---- --------- - <br /> Depth ---------------------------- -Rock Size ------------------------------ <br /> - - <br /> Distance to nearest: Wefh_'�!__E. - "�.- ..-_. ................... Prop. Line ............. <br /> REWIVADIDITtON{Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic <br /> ----------------_. _ --_ -__ ----Septic Tank (Specify Requirements) ------------------------------------------------------------------------------- -------------- -----„ .------------------- ------- <br /> Disposal Field (Specify Requirements) __ - <br /> -------------------- -- ti-- _----------------------- <br /> ----------------------------- <br /> ------------------- -----------_-== --------- ------- - <br /> --------------------------------------------------- -------------- - <br /> -------------- ---------•----- -- - <br /> ` u[r aw existing and required addition ort reverse side_) <br /> I hereby certify that I have prepared'this application and that the work'willAbe done in accordance with San Joaquin <br /> County Ordinances, State Laws; and Rules-and Regulations of the San Joagiuin Local Health District. Home owner or hcen- <br /> sed agents signature certifies`tke following. ' <br /> "I 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 toibecome subject to Workman's Camp nsation laws of California.” I <br /> Signed a --- ------ Owner I <br /> j <br /> By '-------------------------------- --------------------------------------- ------- Title <br /> --------------------- ------------------------ <br /> (If other than owner) L i I C <br /> F <br /> - Y .FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 'BY-C_' htR't _ _- 1-ti ------ '; `= - ----- I <br /> --- -------------- --- � DATE 2-`7�'--�- -- �--- ---- -- --- <br /> BUILDING PERMIT-ISSUED -� �= == ==------ - ----- <br /> - - -- ------__DATE.--------------------------------------- --- <br /> ADDITIONALCOMMENTS _.-. -- "-------------------------------------------------- ---- --------=------------- ----------- <br /> -------------------------------------- <br /> ----------•-------------------- --- ------ - -------------------- -- ---- ------ -----------_------------------------------- <br /> Fin Ins' ---- - ---------- <br /> Fina! Inspectio ------------------- -------------------Date --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.' 9 1-'613 Rev. 5M <br />