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a. <br /> FOR OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT <br /> Permir No <br /> (Complete in Tnpilrato) <br /> - / ' S 449 <br /> Ibis Per nt!Expires 7 Year from Date Inuod <br /> Date Issued <br />`i Apphcatten is hereby made to the San Joaquin Local Health Dis•rict for a <br /> q permit to construct and Install the work herein <br /> descricea This application is mode in compliance with County Orainance No 544 and existing Riles and Regulations, <br /> J08 ADDRESS/LOCATIONr" l�r'cI CENSUS TRACT <br /> 1 <br /> Owners Namr /S//l )/ Phone <br /> Address �f) ,I,f, City 1 � %/l�X rc/( <br /> Contractor s Name .r`ltY/ h oN i 'Yti/ license # ��"s '6 Phone 5'.;lx3 1 J <br /> f <br /> Instollahon will serve Residence jM Apartment House❑ Commercial ❑Trader Court ❑ <br /> Morel ❑Other <br /> Number of living units Number of bedrooms :r Garbage Grinder Le-S-ze <br /> Water Supply Public System and name Private <br /> Character of soil to a depth of 3 fret Sand C Silt Clay C7j Peat❑ Sandy Loom ❑ Clay Loorn 10 <br /> Hardpan [I Adobe (-j Fill MOIL, Of If yes, type — <br /> [Plot plan, showing size of lot loc:tt on of system in relation to wells bui'dings, etc must be placed an revorso side) <br /> NEW INSTALLATION (No septic tank or seepaga p,• pe,rn tt%a if aublic sewer is available within 200 feet,l <br /> PACKAGE TREATME,INT ) ) ,EPTIC TANK[ ] Size 5%r ";� -C/p`/ , Liquid Depth y �� <br /> Cn aty ' (q4 Type/-t` Material Cr'4'G Na Compartments C� <br /> Distance to njarest We'I lIlr I Foundation C' Prop Line <br /> LEACHING LINE [ No of Lines Lengti- of each line �141 Total Length <br /> D Box i Type Filter Materie' fjoCC, Deplh Filter Mate•lal <br /> Distance to nearest Well ,i CC Foundot ion Property :nine 1r <br /> SEEPAGC PIT r I Depth C,iamete- Numbe flock Filled Yea ❑ No ❑ <br /> Water Table Deprh Rock Sir-t Q <br /> Dtitance to nearest Well Foundation Prop Line <br /> PEPAIR/ADDITION IPrav Sanitation Permit 4 Date l <br /> Septic Tank (Specify ReTuiremews) <br /> Dispo,ol Field 1Specrfy Req.nre-n¢nta <br /> (Drew existing and required cdditton on reverse sidef <br /> I hereby certify thor I hwo prepared this application and that the work will be done In accordance with Sart Joaquin <br /> C unty Ordinane2s, Slate Lcws, and Rules and Regulations rif the Son Joaquin Local Health DlsWct Herne owner or liceo- s <br /> srd agants signature certrftos the following <br /> "I certify that in the perrormance of the work for which this permit Is issued, I shall not otnploy any person In such manner <br /> as to berome avaject to Workman's Corrppnsatlon laws of Corifornla " <br /> Signed f• /,IV % v�f "� .°•/1. Owrnnr <br /> By <br /> litle <br /> (If other th-6 owrier) <br /> FOR DEPARTMENT USE ONLY _ <br /> APPLICATION ACCFcTED BY �� , . L 5•-- rs G DATE :,-;--`1 <br /> 8UlLD.NC PEQMIT IcSUED DATE <br /> ADDITIONAL COMMENTS <br /> f rr <br /> FiItal Inspection by vote <br /> 3 SAN JOAQUiN LOCAL HEALTH DISTFICT <br /> E rt 1' 241 h8 Rev 5X% 7/723 M <br />' 13 <br />