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FOR OFFICE USE: <br /> `PPLICATION FOR SANITATION PER�l <br /> - - ---------------- <br /> (Complete in Triplicate) Permit No.7.L:_3.5 3 <br /> ---- ------ --- .......- .. ......... This Permit Expires I Year From Date Issued Date Issued <br /> Application is.hereby made to the an oaquin Local Health Distr4oiljor. a permit-jo construct and install the work herein <br /> in mpliance <br /> described. This application is made h e No)549.and ezisting,Rules and Regulations: <br /> ,. JOB ADDRESS/LOCATION - T �yuu�• CNSUS CT <br /> E <br /> Y._ TRA <br /> Owner's Name -M/._..Q-_B4 VLA_�N-.�,� --/ /�QTIE^S.-..-----_.Phonel�ff..,ZQJJ-, -Q.-.---- <br /> Address Q-.Qt (1� .3.f I7�I (�OL1 City �1T.-_...-.. '----- - -------`-----c------------ - <br /> Contractor's Name. -I - --_-- --- -J-O-N -------------License #/Oasw--.- Phone-5116657&07 <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Cl <br /> Motel ❑Other - - ---- - <br /> Number of living units .-f.)_ Number of bedrooms .3.-------Garbage Grinder -/NO-.. Lot Size .A.02LZA-5 ---- <br /> Water Supply: Public System and name ---------------.-----.-- ---------- ----------Private <br /> Character of soil to a depth of 3 feet: Sand -Silt❑ c:-Clay ❑ Peat❑ Sandy Loam ❑ _Clay Loam ❑ <br /> Hardpan/❑` Adobe t] 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) \ <br /> PACKAGE TREATMENT [ j SEPTIC TANK Size4.X- Z_-X. S--_- - ;-- Liquid Depth 2 if-.-..___. <br /> Copacityc?'Vw - -..-. Type -_�_._.�.�.�.-_rMaterial-04X4kZ No. Compartments 7i- <br /> Distance to nearest: Well ..- - - -�_-__-------------Foundation f -_._--_- Prop. Line 3.00,_--__.. <br /> • - <br /> LEACHING LINE � No. of Lines __3_ ......__- Length of each line_..�0___._..-._ Total Length v2_¢�.............. <br /> r <br /> 'D' Box _C1.)-_ Type Filter Material I L-A u �.-� K._Depth Filter Material _�_1..-r-------- <br /> _ Distance To nearest: Well /619...__.--__. Foundation e;26 -------- Property Line--7O0.._._._.--_ <br /> SEEPAGE PIT ( j Depth _.. ...... Diameter -------------- Number _._.--. . Rock Filled Yes ❑ No Q <br /> o - <br /> Wafer Table Depth --- ----------------------------------- <br /> - -_---- ck S ze ---------------._.--------- <br /> Distance to nearest: Well ---------------­­------------- -----Found0on -------- __._----- Prop. Line _---.--.-..._-__.-_ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------- ----- Date .__-'_----___--- ) <br /> Septic Tank (Specify Requirements) ..-.l-._..............` ' ' ' <br /> ---------------------`-------------"---------------`-------------------------------------------- <br /> Disposal Field (Specify Requirements) ---------------­----------- - » --�-- <br /> : I <br /> _------'------` ------------------------------------ -------------------- <br /> . ...... -- -- ------•--i--- q I ' <br /> (Draw existingand re uired'addition on reverse side <br /> I hereby certify that 1 have prepared this application and tho the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Sdn-Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: Mad. <br /> "1 certify that ' the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to beco zu lett to W man's Compensation laws of California." <br /> Si ed --- ------ T--- � � -� -- - -- - -------- i`?'- ----. Owner <br /> By - �II�CA Title <br /> v _-. - <br /> of a than owner) <br /> FOR DEPARTMENT USE ONLY / <br /> APPLICATION --------- --- ------.---:- --------------------------- DATE . ...- _. .-3./._�Z --------- <br /> BUILDING PERMIT ISSUED ----------------------- <br /> -------------- . --------------------DATE <br /> ADDITIONAL COMMENTS . -- ---------- <br /> - - - -- - - ---- - -------------------- ------------------------- -,---------- ------------- - ------------------------------ ----------------- ----- --------- <br /> Final Inspection by: -- --f ---------...--------------------------`----------_.-------- .. ....Date -... _4 Jam- l 2-?`- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />