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w <br /> FOR OFFICE USE: APPLICATION POR- SANITATION PERMIT <br /> Permit No: <br /> ---- -- --------------------------------- <br /> ------------- (Complete in Triplicate) <br /> --------------------------------- <br /> ------------� Date Issued ----- -- --------� <br /> �/ This Permit Expires 7 Year From 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 /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> J08 ADDRESS/LOCATlO. ! c �z � � -----------CE TRACT ------------------------- <br /> - <br /> ,7 NSUS <br /> Owner's Name * - t----------------------------------------------=- ----- --------- Phone <br /> [ ��- -------- <br /> `7 Cit �' __r '/��-� <br /> Address ---- --- ----- - �' ----- -- �''�-'------ -- ---------------- � Y ------- --------r------------- ------------------------•-•------•---- <br /> 1 r <br /> Contractor's Name . ,11� '. h t ---.License # Phone <br /> Installation will serve: Residence [ J Apartment House❑ Commercial ❑Trailer Court <br /> fl <br /> Motel ❑Other ------------------------------------------•- <br /> Number of living units:-.---- _.__ Number of bedrooms ----- ----Garbage Grinder - ---------- Lot Size _---------------__----------._-----..----- <br /> Water Supply: Public System and name ------------------ -------------------------------------------•-------•------Private <br /> Character of soil to a depth of 3 feet' Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan 06 Xaobe ❑ , Fill Material ----------- If yes,type ------------------------___ <br /> (Plot plan, showing size of lot, location of system in relation to welfs, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic flank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f Size- �,2-- -- -�-X--' --- <br /> - Liquid Depth --�1 ------------------ <br /> ' 1 c C <br /> Capacity Type Material--- –_---- No. Compartments ;Z-------------- ---- t� <br /> Distance to nearest. Well ----------------50- `.-.---------Foundation -----I G_-`------- Prop. Line -------5 ------- <br /> LEACHING LINE [V No. of Lines -----–3-------------- Length of each line-------.--- G'-_-r------- Total Length --1-----------­----- <br /> D' <br /> ------------- <br /> D' Box -----(------ Type Filter Material -----4� ------Depth Filter Material ---------1 1------------------•-•----•- -- <br /> i <br /> Distancelto:nearest: Well ---_:_S ,-�_-- - Found_ation_-;._/_Q-.'---_------,.Property.Line„-----�....--•..... - <br /> SEEPAGE PIT [ Depth ____.: -- -- Diameter ------ Number ---------_-_ _-_-- -- hock Filled Yes ( No ❑ <br /> -Rock Size __�_-1 ----X-=3-_---- <br /> Water Table Depth --------------------��-�---�-----•--------•- � <br /> F Distance to nearest: Well ------------- e)C5 _._Foundation ------/_- 2_.f----- Prop. Line -------;77�......... <br /> r <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------- -------------------------- <br /> Septic Tank (Specify Requirements) ------------------- -----------------------------------------------------•---------------------------- <br /> Disposal Field (Specify Requirements) ------------- ---------------------------------------------------------------------------------- <br /> ----------------------------------------•----------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application 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 Local Health District, home owner or licen- <br /> sed agents signature certifies the following: <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 <br /> as to become subject to Work s)Compensation laws of California. <br /> Signed ----:--------------------------- ---- r ---- --__ Owners+ R <br /> ---- —-- Title -------------- . <br /> [lf other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- --------------------------------------------------------------------------------. DATE /D-3D-_7Q------------ <br /> BUILDING, PERMIT ISSUED --------- ---------------------- - ----DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS --------- --------- -------- <br /> - --- ----------------- -- ------------------------------------------- <br /> -------------------------------- -------------- ----------- --- ----------- ------------------------------------------------------------------------------ <br /> - _ <br /> ---------------------------------------------------------------- ----------- - ----------- <br /> Final Inspection by: ------ -'°�-- --------Date jU� �`3�- � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />