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_ FOR OFFICE USE: -nPPLICATiON FOR SANITATION PER@IT( 0 <br /> Permit No. -.�3'�----- <br /> -- - (Complete in Triplicate) <br /> ------------------------------ P �7- <br /> r. - - This Permit Expires 1 Year From Date Issued Date Issued <br /> --------- <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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LO -------.-... _. . -. W...._ <br /> -- ------------=- - <br /> . c---------------- <br /> %I -------- -------CENSUS TRACT ------- --- " <br /> L Owner's Name . - - -------- <br /> --- - Phone ------------------------------ <br /> J} <br /> Address .-- ------------- �- �C�.... City ---- <br /> _734F <br /> -- .. . - - <br /> Contractor's Name ---- fYXr<t sz--- .-- - -"-- - ----------- <br /> Installation <br /> � = --`-.------License # -I� 3 y`-- Phone --------------------•------- <br /> LInstallation will serve: Residence DkfApartment House❑ Commercial❑Trailer Court L] <br /> Motel ❑Other <br /> Number of living units:_.---- ... Number of bedrooms ....>:_Garbage Grinder .__------.. Lot Size .. f ------------- <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 G� 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 permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t ], . Size-----------------.----------- ------------------ Liquid Depth --------------------- <br /> ` Type .--- . Material.._.-_----._-_--- No. Compartments ._------------------- W Capacity . - -- - YP N <br /> Distance to nearest: Well ------------------------------------Foundation ..-------------------- Prop. Line -----..------------- <br /> LEACHING <br /> -- -------LEACHING LINE [ ] No. of Lines ----- Length of each line............ ........ ...... Total Length ----------_........._....- <br /> 'D' Box ------------ Type Filter Material ....................Depth Filter Material ----------- ---------_-------------------- Z <br /> Distance to nearest: Well -.------_--------- ... Foundation ----------------------- Property Line --------- ---------_-- - <br /> LSEEPAGE PIT [ ] Depth -------------------- Diameter --------- ----- Number --------------.------------- Rock Filled Yes ❑ No C3 %A <br /> Water Table Depth ............... ....--------............ ....--Rock Size --- <br /> i <br /> Distance to nearest: Well -------------_----..-------- ...._Foundation .........-------_- Prop. Line _----------- ------- A <br /> M <br /> ` REPAIR/ADDITION(Prev. Sanitation Permit# ..............-------------------------..... Date .......... -------._--.---..-----) <br /> Septic Tank (Specify Requirements) ---------_- ----- ---------- "---- --------------- ----------"------�--- ------- - ^----- <br /> Disposal Field (Specify Requirements) .. .._IA.-F.F:K-_/.�1--...�f`- - <br /> elz <br /> -- -"--"-------- <br /> -. . .................-. ­---------­------------------- "------- <br /> _ _ <br /> ---..-.....--- .-..--.._..---_ '--..----"---------'--------"- -----" <br /> _._.------"-_ .-._.._.._...---__.-...-.- _-__-_............ . <br /> L (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 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed - ---------------------------- /� r - -- Owner <br /> L ---- r-' ���`/ • Title - <br /> By ----------------- --"- - /' -. <br /> (If other than owner) t" <br /> LR DEPARTME11T USE ONLY <br /> APPLICATION ACCEPTED BY -------- - - - �7r: ' - ----------------------- ----------------- DATE --- rA--- ------?-3--------------- <br /> BUILDING <br /> "3-------------- <br /> BUILDING PERMIT ISSUED ---- -------------- ------------------------------------- ---- ---------------- - DATE --------- --"------- <br /> LADDITIONAL COMMENTS ------------ - -------- - ---------...------------------------ ---------- <br /> .. ... ------------------------ .A . .__________ _____________ .------------­---------------- . <br /> f,� ­_j' <br /> Final Inspection by: ..----------- - - -".+ »He: :,.,---'--`'--- -------------------_---------------------------------Date - ----a`--`��------------_--- <br /> 1r SAN JOAQUIN LOCAL HEALTH DISTRICT <br />