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''OR OFFICE USE: <br /> ............. APPLICATION FOR SANITATION PERMIT <br /> ........................................ <br /> ICotnpieM in Triplicate) Permit No. ...7 ....... <br /> .._..... This Permit Expires t Year From Date Issued Date Itsuad ...... . <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 comp�-p-liance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION......../ iii._.. �,• /�/.•-.-• •_�/e. a zENSLIS TRACT ....0.40........... <br /> Owner's Name _.._....... Qn hl.!✓. ......../ A�/. ............................. <br /> Address ................................. .Phone .f 3-lezl........ <br /> ss ........- J.'7 p. .5�...C.�! 111 .,✓._.. <br /> p ............... <br /> Contractor's Name License ---•.................... Phone --•--•----.._. .......... <br /> Installation will serve: Residence par#ment Houser Commercial flfrallsr Court ❑ <br /> Motel❑Other............................. <br /> Number of living units:._.... ..._ Number of bedrooms 1 Garbage Grinder Lot Size v <br /> Water Supply: Public System and name ................ Private ( / <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay O Peat❑ Sandy Loam C] Clay Loam ❑ <br /> Hardpan❑ 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.) tq <br /> NEW INSTALLATION: (No septic tank or spit permitted if public sewer is vailable within 204 feet,{ � <br /> PACKAGE TREATMENT [ ] SEPTIC TANK eepa Size.... 00 <br /> �...�.. . I.�. ............... liquid Depth ------....._......._....._ <br /> !!�� 111 <br /> Capacity 1400...... Type f,0.r,,s.--/.__ Materia!- No. Compartments ... <br /> I! rZ............ <br /> stance to nearest: Well _.___...c.> ............. Foundation ..O.............. Prop. Line ...................... <br /> LEACHING LINE [io. of lines -. ✓ e <br /> Length of each fine..........- ©--.------ Total Length .............. <br /> 'D' Bax ...... Type Filter Material .Depth .Filter Material ........11r........_.._.. <br /> Distan to nearest: Well ...... .0 .. <br /> __......._ Foundation .... Q�. <br /> Property Line .......................� <br /> SEEPAGE PiT [ J Depth ---- --------------- Diameter ................ Number .---....-------------....... Rock Filled Yes ❑ No <br /> 0+ <br /> Water Table Depth <br /> ............. ..................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .............. Prop. line ..............-......5'` <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................... ...._-----------.-._. Date ................................ �a <br /> ..} t <br /> Septic Tank (Specify Requirements) ...:.................................................................... <br /> Disposal Field (Specify Requirements{ -•-•_-_._..: ..................................................... -•...-•------................_...----------....... ................. <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 clone In accordance wills Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Horne 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 man <br /> as to become subject to Workman's mpencs-a�tl n la of California." <br /> Signed ....Ja .. f 6 <br /> - - � . . ..... ... . ..... ._.._ Owner <br /> By .......... ..... ........... .......•-----------.........-------------------------------------.------- lit'.........-- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... ... ..- . ..._ 2 --- <br /> lL-I/ -------------*._...--•- . DATE ...t��....c3.I.,.?.J...__... <br /> BUILDING PERMIT ISSUED .......-- DATE ... <br /> ADDITIONAL COMMENTS ..... ..._._ ---.............. <br /> ..................... .............................................................=........................... <br /> ................ ..................... ........ <br /> ---------------------------------....--•------.....---•-......-----•--------- <br /> Final Inspection by-. ._._.. �++ <br /> Date .S. <br /> 13 2a 1-6 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 8/7h 3M t <br />