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FOR OFFICF USE <br /> APPLICATION FOR SANITATION PERMIT <br /> :o,nplett in Triplicate) Permit No. _7.3,52:7.... <br /> This Per n , 'xpires T Year From Date Issued Dote Issued ... ]-.t.-1. .. <br /> Applicorion is hereby made to the San Joaquin la Avolth District for o permit to construct and install the work hereir <br /> described This application is made in compliance w th County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS,/'LOCATION .29G•�.,J ttYi I CENSUS TRACT <br /> Owner's Nome .t'*�. �� �..---.. ....... ......Phone .................................... <br /> Address � ,c <br /> 1��. lL1:C..A40 City ...L.C...61l.' <br /> Contractor's Name C�/1-z�L� c c. ..~. c... -..license #���3�v.. Phone ........................... <br /> Installation will serve: Residence Apartment House❑ ornmercial ❑Trailer Court <br /> i <br /> Motel C]Other <br /> Number of living units: Number of bedrooms ............Garbage Grinder ............ lot Size ............................................ <br /> Water Supply: Public System and name . .................................... ..................................................Private ' <br /> Character of soil to c depth of 3 feet: SandSilt Clay ❑ Peat E) Sandy Loam Clay Loam p <br /> Hardpan L7 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permittedCif public sewer is available within 200 feet,')/ <br /> PACKAGE TREATMENT j SEPTIC TANK Size 1.� ��.�✓. >.�... . Liquid Depth , /` .................... <br /> Capocity3��CC"�/Type �..4.v. Material. �C�-C__ No. Compartments ....3............... <br /> _-Foundation .... �.4'. <br /> Distance to ncor >s: Well . ....�...�✓.�_ _ Prop. line ...�.- .... .- <br /> LEACHING LINE jr1 No. of Lines - Length of each line Total length <br /> .. . <br /> 'D' Box Type Filter Material .....a..P,....Depth Filt Material . ...f.�j..��.......... .............. U) <br /> Distance to nearest: Well . f.S 4'.. Foundation _ .�0. Property line ....--M <br /> .. ........ Z <br /> SEEPAGF PIT Depth r -P Diameter %� .... Numbe- . . <br /> .......... Rock Filled Yes (� CDNo <br /> p �.S ... �. <br /> Water Table Derth ._. .. ...r -f... . ...___......Rack Size ..A ... /+'... ........ <br /> Distance to nearest: Well �/ L/ .. ... .....Foundation . if. .. Prop. line ... <br /> REPAIR/ADDITION(Prev. Sanitation Permit . . .. _ ... Date .................................I <br /> Septic Tank (Specify Requirements) . _... .............. ....... .......... ..............................-- <br /> Disposal Field (Specify Requirements) .__ ...... _.. _ ... . - . ...... •� <br /> ............................. <br /> ...... ...................... <br /> (Draw exist rg and required addition on reverse side) <br /> 1 hereby certify that 1 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. Hem* owner or lictn- <br /> sed agents signator*certifies the following-, <br /> "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to became subject to Workman's Compensation laws of California." <br /> Signed3 `� l/` Owner <br /> gy C lC( ��! (' title ��IC �C <br /> (If other tho owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION! ACCEPTED BY N� , + . .�.,_ DATE .. ... .. <br /> BUILDING PERM17 ISSUED DATE <br /> ADDITIONAL CO.'.A'11ENTS ... ...... ........ <br /> i <br /> F,n�1 inspe-t on by. 4._ / aC�C pa.e <br /> N JOAQUIN LOCAL HEALTH DISTRICT / <br /> it <br /> +� M' <br /> t.'69 Re.- r..1 <br />