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FOR OFFICE USE: <br /> 4,,?PLICATION FOR SANITATION PEI _,-,T <br /> ... <br /> (Complete in Triplicate) <br /> ................ ...... Permit No. .. ~s L L <br /> ......... . ..... . . ......... .................. This Permit Expires 1 Year From Date 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 /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS LOCATION _ �` i LG1 � `�'. '� . ..... .L'` r <br /> #`..-. ... y.c :..� { ...... ltavAENRU TRACT <br /> Owner's Name .. =::.............`... ..... �Phone ...................--- ....... <br /> Address X!V.-�!-,—vX /�L ��;�, l �. <br /> ........ . .-. ..- ....�...i4.N/`1.'----�.r�.'1?•................... City ..�.L.....-- �-'--•------.... <br /> '` (S1� <br /> Contractor's Name ...... �G��`' ...................... ................License # � Phone .�lr........:.....1.Lr..... <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other .-- ......... <br /> lat C.. <br /> Number of living units:...,-.�Number of bedrooms .—.—.—­GarbageGrinder ......fSize ... <br /> Water Supply: Public System and name .............................. ................................................................................Private <br /> Character of soil to a depth of 3 feet: Sand n Silt❑ Clay,E Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material .lr.!.4. .. 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f I SEPTIC TANK I-r l D Size......y-X. .X. ..�.c '.................. Liquid Depth ................... <br /> Capacity ........ Type A_%k..: °.Material... Compartments .�--........... <br /> Distance to nearest: Well ....... -��..r.. . ....Foundation ...../P.!........ Prop. Line ...`.. ........... <br /> LEACHING LINE [6}j/No. of Lines .................. Length of each line....... ............. Total Length ....-'���............ <br /> . <br /> 'D' Box 414 .-. Type Filter Material .....Depth Filter Material ..................... <br /> Distance to nearest: Well ...- �1............ Foundation ./_A-1...........---- Property Line <br /> SEEPAGE PIT Depth ... ......... Diameter 5Ixe....... Number ..........i.----.gg..f.....__ Rock Filled Yes jJ—No Q <br /> u Water Table Depth ........._74" Rock Size ...ail. .X:. ............. <br /> Distance to nearest: Well ........ ................Foundation .../A.1...... Prop. Line S?.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................_) <br /> SepticTank (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 H*olih District. home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance'al the work for which this permit is itsu*d, I shall not *mploy any person In such mann <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ....................... ........................... ......................................... <br /> Owner <br /> By . _--...�.. .. .........••.•.••......— Tel .......�_ �:1c.: .1. :.- `'.� ......................... <br /> (If other, h ri owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ......ti'i , ....... ...................• ---•--•----- ......................- -----. DATE ..b.`a.p = 7., ................ <br /> BUILDING PERMIT ISSUED ...............r ................---..DATE ........................................... <br /> .......................... <br /> ADDITIONAL COMMENTS ..................... _...............................-......-............ <br /> ............................................ <br /> ..................................... <br /> ..Final Inspection by; .............. .............................................Date ...-�..� . .�L.:~1 ............. <br /> SAN JOAQUIN LCL HEALTH DISTRICT <br />