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,.r <br /> FOR OFFICE USE: I <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. . s..� `� <br /> (Complete in TriplicMe) - <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is ' -by made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. Th; plication is made in compliance with Count Ordinance No. Sd9 and existing Rule- and Regulations <br /> JOB ADDRESS/LOCA—T-10 HNC= 1I-'�4. . '�r� iL/�/�U�� `J CENSUS TRA r�pn <br /> Owner's Name kJE C�� f��1 tet/`./' LTJ. .... . .. . _ _ Phgne . .:./....(/. <br /> Address2�F � f cam. / �rA�>`._._ _... ..-. City ��cf}"/O� p.-�................r.�........ <br /> Contractor's Norne G�a f el 14 (-t. 19 C".�C= License #��S�f- Phone <br /> Installation will serve: Residence Apartment House[] Commercia; ❑Trailer Cou•t <br /> Mote [)Other _ ,[ <br /> Number of living units:x-5 Nimber of bedrooms / .....Garbage Grinder L^t Size <br /> Water Supply: Public System and name . .... ...Private [ <br /> Character of soil to o depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sondy Loam j-] Cloy Loam <br /> HordoanAdobe ❑ Fill Material IF yes,type <br /> (Plot plan, showing size of lot, location of system in relation to wells buildings, etc' must be placedonreverse side.; <br /> NEW INSTALLATION: (No septic tank or seepage pit permi!ted. if public sewer is available % ithin 200 feet,) <br /> PACKAGE TREATMENT ( 1 SEPTIC TANK ( J ^ Size J O Liquid Depth <br /> Capacity �2�C� Type c� Cf�Mc-teriul ��rWe; (fNov. Compartments 2. .......... N <br /> Oistonce to nearest Well ,SIC <br /> 1 , < Pro Lin. <br /> C� Foundati,>n p. �' <br /> r � <br /> LEACHING LINE [ ) No. at Lines Length of each line Total Length lrE' <br /> rr qrr <br /> 'D' Box Type Filter Material 1 '�Z Dept;•. Filter Material <br /> Distance to nearest. Well 7C) Fovndatiort Property Line <br /> -f/ r <br /> SEEPAGE PIT ( ( Depth /r7� Diameter jCL' Nu, ibe- !f Rock Filled Yesr No Q n <br /> Water Table Depth � Rock Size <br /> Distance to nearest. Well Foundation j-• Frop. Line eb <br /> REPAIR/ADDITION IPrev. Sanitation Permit# Date 1 } <br /> Septic Tank (Specify Requ,rernents) �y <br /> C <br /> Disposal Field (Specif,• Requirev^nl.i <br /> (Drew existrn(J and rc- uired addition on rr,,erse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Roles and Regulations of ►ho Son Joaquin Local Health District. Home owner or licen- <br /> sed -�,en•s signature certifies .he following: <br /> "I rertify that in the performorre of the work far which this permit is issued, I shall not employ any person in such manner <br /> as to become subject tf WRman's Comp,_nsation lut_O_f-California." <br /> Signed L �l. �t r s e �', ("•... L(� �.. c: Owner <br /> By e -� .. �_� Cc L.t— 7irle l% 1 <br /> �, 'her than owned <br /> FOR DEPARTMENT USE ONLY <br /> APPL:CATION ACCEPTED BY �/f �/ " „ DATE <br /> BJILD!NC PE4hrli ISSUED DATE <br /> ADDITIONAL COMMENTS <br /> Final Inspecrnon by <br /> ,, ,,. ;C r• :i.)t , !Cjr!•i tIEALIII UIST4rr:. <br /> F 11 .' bu Rev ,r.', <br /> 1;7Z 3 <br />