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FICE USE, <br /> FOR OF ' T f ,APPLICATION FOR SANITATION PERMIT <br /> . 3. ..3. 0 Permit No. -GfJ y�Z <br /> ,`. - /,,x•s _ (Complete in TripEcohil i <br /> Dave Issued . <br /> This Isermll Expires I Year From Date issued <br /> Application is hereby made to the San Joaquin Local Health Disa:ct for a perms to construct and install the work hereto <br /> described. This opplication is mode in compliance with County Ordinance No. 549 and existing Rules and RegulaKom <br /> JOB ADDRESS/LOCA�1pN .7--�r.;.,J-.e-,, )�X� "/' y� - CENSUS TRACT _........... <br /> Owner's Name ..., t'f.. p.t� .c.!^,.stge7t./sf-'y77.'f2/�rc <br /> Address ��5". ..♦ .. .+J-[Oen / ! .City •V�ci'�!'r-lliK.._...._..�._..__...._. <br /> Contractor oirl- -.�.te• e .-/ � • _.licenu# 4 Y i._ - Phone `.1.... ....._....___ <br /> Installation will serve: !C Residence❑Apartment�House❑ Commercial[7;oiler Court ❑ <br /> Mittel❑Other lEJ�`�{ <br /> Number of living units! .. . Number of bedrooms ............Garbage Grinder Lot Size ._.. .__._ ------- ----------- <br /> Waver Supply, Public System and name _......... . _. .............. _- .----.._.......... ._ ... ...................private <br /> Character of soil too depth of 3 faet: Sond❑ SW❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam fl <br /> Hardpan❑ Ad* Fill F81 Materiol If yes,type -.... _. --------..----- <br /> (Plot plan, showing size of lot, location of system in relation to weils, buildings, etc must be placed an reverse side.l <br /> NEW IM"ALLATHMs (No septic tank or seepage pit permitted if public sewer is available wPhin 200 feet,) <br /> PACKAGE TREATMENT I ] SEPTIC TANK( ] Sin.. . ....... ...._. .. .. . Liquid Depth ......-................... <br /> Capacity . Type ._.__.._ Material No, Comportments <br /> Distance to nearest: Well _.... . . ._..Foundotmon - ...- Frop.Lim............._..__. ��VVJJ�1 <br /> LEACHING UNE [ ] No. of lines . Length of each line Total Length ........._................ Q <br /> 'D' Box Type Filter Material ..... ._. .Dcp1h Filter Material __ ............. .........._.....«...- <br /> Distance to nearest, Well Fovndation Property Un, ....................... <br /> SEEPAGE PIT ( ] Depth Diameter Nvmbe Rock Filled Yes ) No ❑ <br /> Water Table Depth .. Rock Size <br /> Distance to nearest: Well Foundation Prop. Line .........__....... <br /> REPAIR/ADDITION(Prov.Sanitation Pcrmit 0 _ Dat, ... 1 <br /> Septic Torok (Specify Requirements) / - - - "" \4 <br /> Di 11 Fiel ISPecifY Raqurrementsl e4ea <•C C�.[wtvc..-`Nr� �C�+''`` -`> <br /> {a/ / rlY ^ Ti <br /> (Draw exat:ng and required odde.cn on reverse side) <br /> I hereby conify that I have prepared this application and that the were will be done in accordance with San Joaquin <br /> County Ordinances, SMB Laws, and Rules and Reg+lon'sas of the Son Jocsivin Lecel Health District. Hem, owner Of licen• <br /> sod agents signature c,rtifies the following: <br /> •': comfy, that in the perfersrtenc,of the work for which this permit is iswed, 1 shat! net .rrsaloy anY Perso, in such manner <br /> os to becopse subject to Workm "s Cemp,nseNeyrlaws of ColiFomia" <br /> C <br /> Signed •• ,AJ�tz .. 0«�.. <br /> By <br /> N cher the, oxne•! <br /> •/i' RTMENT USE ONLY <br /> ty!� <br /> APPLICATION ACCEPTED BY <br /> 8UiLD!NG PERMIT ISSUED <br /> .10DITtOtJAL�COrN TS <br /> I'm 31 Inspec"on by: <br /> E 49 Rev 5M <br />