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EOR OFFICE USE: <br /> Y APPLICATIOWFOR•"'ANITATION PERMIT qc� <br /> _ , <br /> ----------------- ----- -------------------------�-- i(Complete n Triplicate) Permit No. 3-~---(Cl--- <br /> �I Date Issued - - --. <br /> _-_---_---------------- This Permit Expires f Year From Date Issued <br /> Application is hereby made to-the-SrM-JoaquintcrcalHe'ulth-D!strict-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/LOCATION _h ----,i"x,/ L ,�f44' -----------------------------=---------------CENSUS TRACT -----------------•-------- <br /> Owner's Name -- <-�,-------/7� / s.4'� -------- --------------------------------------------------------Phone ------------------------------ <br /> ---------- <br /> --- --------------.... <br /> i Address { �__ ., ex-------------------------------------- City <br /> Contractor's Name ------------------------------License #ol. � - Phonesa -- • <br /> I a <br /> Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ',❑ <br /> i Motel ❑ Other -------------------------------------------- <br /> Number of living nits:__-/----- Number of bedrooms ___ r <br /> ____Garbage Grinder Lot Size _n .0.�a- <br /> 4_ ------__--_----- <br /> Water Supply: Public System and name _Z�kr:�------4&40 ---++��1�`�------------•- ----------------------•---------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe'L9 Fill Material ------------ if yes, type ------- --------------------- <br /> (Pl'ot plan, showirf Siye hof lot, location of system in relation to wells, buildings, etc, must- be placed on reverse side.) p <br /> NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r <br /> PACKAGE TREATMENT [�-]J SEPTIC TANK,Y, Size -,�5" �_:""_____` Liquid Depth --------------- <br /> Capacity «_e_P,___ Type��/,c4MaterialNo. Compartments --;7— <br /> j <br /> Distance-yto--nearest. -Well ------------- ----- :Fo dation _-/a------------_ Prop. Line -- ---- - <br /> ------ <br /> LEACHING LINE No. of Lines ___._./.____--__--_- Len h of each line-- Total Length _.J to-r________-____ <br /> 'D' Box /lel__ Type Filter Mate 'al`' 4 Dep Filter Material gip_ ________________________________ <br /> ,., <br /> 4 Distance to nearest: Well ____:_""-"'___--__---- Fo�n 'afion '___ ------------ ___4 Property Line, ___ ____`-____._..-_.11 . <br /> I SEEPAGE PIT K Dhepth Diameter , --------------------- Rock Filled Yes N i❑ <br /> Water Table Depth ------- - ----------- Rock Size ---•--•---- , <br /> __Foundation _ - --� .-____ Pro Line __ _ ......`.._ <br /> Distance to nearest: Well ------ '-`___________________ �� p• � -- <br /> 0-_ L; <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- =-----"----------------- Date ,--------------------------------- <br /> Septic Tank'(Secif Requirements) <br /> AY <br /> P \ Ap Y ---- ------------=--------------- 9__________________---------------- --- ---•------------------------- ­­-------------------------- <br /> Disposal Fielel, (Specify Requirements) --------------4'''--------- -- ------------------------=--- ---------------------------------------------------------------------- <br /> I� f ` <br /> -- . <br /> ----------------- ------------------------`--------------------------- ;------- = <br /> I` -. .. } --------------------------- -------- ------------------------- ---------- <br /> I <br /> r �{ <br /> i (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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> : . -_-- _ Owner. <br /> Signed ----------------- -- ---�-------- ------ -------------------------- --- - <br /> - - ------------------------ <br /> ------------- Title _ — ---------------------------- <br /> Y her than owner) <br /> Ip P ENT USE ONLY <br /> r APPLICATION ACCEPTEDI BY -- -------- - ------ --- ------ DATE ----- - ------- <br /> ---BUILDING PERMIT ISSUED --------- --- -------------------------------------- -----------DATE ------- ----------- <br /> DDITIONAL CO NTS - --- ----- - --- ------- ------------- <br /> --------- <br /> ------------------------------------------------- -----------=----/-- <br /> -- <br /> ------------------- <br /> -1COM <br /> i -- - --------------------------------------------------------------------------------------------------------------------------- <br /> ------------- ------------ <br /> I -- - Date7 <br /> Final Inspection by.. - - -- - - <br /> -------- <br /> SA ._JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1--'68 Rev <br />