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€ , FOR OFFICE USE: <br /> ,'PLICATION FOR SANITATION PER., <br /> - -- -------------------- Permit '7 -`/7 7 <br /> (Completer in Triplicate} it Na. .......�.-..---.-- <br /> T .................................................. This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ' JOB ADDRESS/LOCAT ON -_----- ------------------------- -------- -----CENSUS TRACT ... . --.........-.....- <br /> Owner's Nome 1------------------ ----•---------.--- ----- •----•-•-- ...----.....---....Phone --..............---••-- <br /> . ............ <br /> Address - -- ivy ----. <br /> - Ci#Y � , F..--------------•-----.. ........................ <br /> Contractor's Name ...- .. C" ---------------.---- ------.License # ': . Phone <br /> Installation will serve: Residence ❑Apartment House 0 Commercial ❑Trailer Court <br /> Motel ❑ Other ----------------- ------------•--------- .. <br /> i . " <br /> FNumber of living units-de/7... Number of bedrooms/Jly---Garbage Grinder ------------ Lot Size ............. <br /> . Water Supply: Public System and name ------------------------- • ---------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt)] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan E] Adobe jR Fill Materiol ...--...--.- If yes, type ---------------------------- <br /> F{ <br /> {Plot plan, showing size of lot, locution of system in relation to wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: (Na septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size..........------------------.------------------- Liquid Depth -------------_--_-__------ <br />` Capacity .. ............... Type ------•-----•-•---.. Material-------------.---- --- No. Compartments p 0 <br /> Distance to nearest: Well --------------- .................Foundation --------------------.. Prop. Line ....................... <br /> 00 <br /> LEACHING LINE [ ] No. of Lines ---- ------ Length of each line---------------------------- Total Length ------------ ............... p <br /> F. 'D' Box -........... Type Filter Material ....................Depth Filter Material ----- ...................................... Z <br /> Distance to nearest: Well ........:................ Foundation ........................ Property Line ------------_..__._-.., j <br /> SEEPAGE PIT [ j Depth ........_..p-_.. Diameter Number ---------------------------- Rock Filled Yes C3 No C3 <br /> i � Water Table Depth -. -- _ <br /> - - - Rock Size •............................... � <br /> Distance.to nearest: Well ......----------------.......•..........Foundation -------------------- Prop. Line .......................7P <br /> REPAIR/ADDITION(Prev. Sanitation'Permit # ---•---------------------------------------- Date ....................... .. 1 <br /> } <br /> Septic Tank (Specify Requirements) ..... ....... Y <br /> ? <br /> ----------- <br /> 7 ------------------------------------------•--- - --.---- <br /> d� rlDisposal Field (Specify Requirements) s � ---- 61- j <br /> Ell <br /> ------.a/ ',�1%' l T-. ......--.' -, i ---------- -----------------------------------------------------•---------- <br /> .�;�.-x �'s�' =����i P�� ���/ --------------------------------------_,_..... ........ ---..--._....---.....--_. <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 Health District. Home 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 shallnot employ any person in such manner <br /> as to became subject to Workman's Compensation laws of California." <br /> Signed ...... .......... -----------------------------------4"----- <br /> --------------------------------=•--••-•--.- Owner <br /> F" <br /> By ---- ------------------------•- ----------- .Title ................. <br /> If other t�wner) <br /> F DEPARTMENT USE ONLY , <br /> F APPLICATION ACCEPTED --: DATE ��•.7 --------------------- <br /> BUILDINGPERMIT ISSUED ...._•............... ....................................,..-.....................................DATE ........................................... <br /> ADDITIONALCOMMENTS --------------- ------------........ ............................................................ <br /> --------- ------- ---•---- ........------•--- . <br /> k : ----- ••--- --------•----'-----------------------_-.------------------------------------- ------------ <br /> ................................... <br /> Final Inspection by: Date ..(�. - j-/T ------------- <br /> {+� - <br /> ! SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br />