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r77 <br /> FOR OFFICE USE: <br /> {'•e":;:' PPL PERMIT p <br /> 7 �i G�... <br /> (Complete t T i I Permit No. . <br /> A fC TfON FOR SANITATION <br /> :7' y.. rr n rtpl tale•••.••...•.•.... .... Thi/607 <br /> ermit Expires 1.Year Frem Date laved ,,/ <br /> } ; LL........ Date Issued...V-a5 ,.0'.. <br /> i r� fit; Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work'fterotn� ".� <br /> ,� ,• v�. described.This applitation is made In compliance with County Ordinance No. 49 and existing Rules and Req ulV. <br /> ettonse�:.;�,` <br /> JOS ADDRESS/LOCATIOQ.. ' �sl .................CENSUS TRACT <br /> r tl <br /> Owner's Name ... Phone h..�.... .Cr <br /> r s r a e a <br /> Address � ............. : � �. City . ................ <br /> Contractor's Name ...... .License # Phone'T��..1..�{� <br /> {. • Installation will serve, Residence❑Apartment house 0-Commercial ❑Trailer CourtJI <br /> Motel❑Other 'r <br /> Number of living units:............ Number of bedrooms ............Garbage Grin.4er ............ lot Size .. ...._..�"`� ay <br /> y <br /> 5`L,a Water Supply: Public System and name ........................................................_..:.::...-.............-...............•-•---......Privets Y <br /> rf <br /> 3 Character of soil to a depth of 3 feet: Sand❑ Sift© Clay ❑ ;Peat[3 Sandy.loom ❑ Clay Loam( <br /> EHardpan❑ Adobe ❑ Fill Material........ If yes,type <br /> { (Plot plan, showing size of lot, location of system in relation to wells, buildings,`.etc. 'must be placed on reverse 'side.) `t <br /> NEW INSTALLATION: (No septic tank.or seepage pit permitted if public sewer is available within 200 feet,) <br /> r : PACKAGE TREATMENT [ ] SEPTIC TANK; j Size.....................: ...:................... Liquid Dept! ....................... <br /> f <br /> Capacity YP � ... <br /> .....--.... Type .:.................. Material.....:.-..--..-....._. No. Compartments ............... <br /> Distance to nearest. Well X,:} <br /> [, ...............................Foundation ........ ....... Prop. Line........._.......... <br /> LEACHING LINE [ ] No. of Lines ........................ Length of each line....--..................--.. Total Length <br /> D' Box Type Filter Material ..Depth Filter Material <br /> I•"+'% Distance to nearest: Well ...................... Foundation ........................ Property Line ......_................ " <br /> SEEPAGE PIT ( � Depth . Diameter Number ..................... ...... Rock Filled Yes ❑ No (] p <br /> Water Table Depth <br /> . ................................................Rock Sire ................................ <br /> Y <br /> D.stance to nearest. Well Foundation Pro Eine <br /> REPAIR/ADDITION(Prev. Sanitation Permit#............................................ Date .................................. <br /> Septic Tank (Specify Requirements) ..... ..•........ <br /> ............................ .... �.. ... <br /> Disposoi field (Specify Requir encs} . .........'"'""- c'f ..., - ............. <br /> ......... <br /> ........................ x <br /> q / <br /> J'........! sir or. L!_.1.4-41 r,l <br /> Css.jr�j ,r a., Q�tu ,f , gw eX9tt7ngLannd required a��i on`on rbttvEfsse sid6) f <br /> } G I hereby certify that I have pfepareedd lfsis ap/ph,6Q4 A&fh the work ,rJl ,ne do a in acco once San Jeaqutn <br /> j f County Ordinances, State laws, and Rules and.Regulations of the San Joaquin Loo al Health District. Home owner or Ilcen. f <br /> r sed agents signature certifies the following:' <br /> "1 certify that .n the performance of the work for which this permit is issued,•I shell not employ any person In such manner } <br /> k as to become subject to Workman's Compensation laws of California." <br /> L <br /> ... � signed ...... ... ..... .....-.. .... ............................................ Owner <br /> • � By....... ... . ....... . . ....._..... ........ Title . .... • i <br /> Y. (If o than ownerl <br /> DEPARTMENT USE ONLY <br /> APPLICATION CCEPTED BY ..... . ?.. �..:C. DATE . . .-��y-� •............. ; I <br /> ....................... <br /> BUILDING PERMIT ISSUED <br /> 1j e` i...... ✓ ./.-/y..�....... <br /> . p..ssTE <br /> ..................ADDITIONAL COMMENTS .......... . ... ..... <br /> ....- <br /> . cC ,,5 <br /> .. ... .. <br /> FinalInspection by; 1—.......... ...... ....................... ........... .............I..... ........... ...........- Date .................. <br /> 4,,f„�� / SAN JOA JIN LOCAL HEALTH DISTRICT <br /> 00 <br /> 1 E. H. 9 1-'6E Rev. SM <br /> f 4� <br />