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t- eq .r <br /> FOR OFFICE USE: APPLICATIONFOIA SANITATION PERMIT <br /> ...........................• -------- <br /> (Complete in Triplicate) Permit No: ...................... <br /> ..........•-.............................................. <br /> 2-7 <br /> .................................-...........--,• This Permit Expires 1,Yew From Dat*issued Dote Issued ........ 1 <br /> Application is hereby made to the Son Joaquin Local Health Distric} fora 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 a __Is-•------.p,P.I1C --------------- .........� _------.__CENSUS TRACT S.-.Y-7 <br /> _____• <br /> -----------------------Owner's Name -y <br /> Phone <br /> Address . ! ...................................... <br /> -----�. 1_�1 .. � _t-) t....... ---•---- ... city ----• c 1 �. <br /> Contractor's Name -- --------Q.1U -___.-_-__ ...___________________________________License #�._ .................. Phone .............................. <br /> Installation will serve: Residence 2-A-partment House F1 CEmmerc 1 []TrsalerCourt C] l� <br /> Motel ❑Other -------------- <br /> ) <br /> Number of living units:......! __._ Number of bedrooms ______Garbage GrindeY ILot Size __.R �ti _± <br /> Water Supply: Public SystLim and name ________________•--------•---....., -•------ r - - L " Private <br /> Character of sail to a depth'of 3 feet: Sand Silt❑ Clay Q ,4` Peat❑/ 7Sandy Loam❑ Clay Loam r] <br /> Hardpan ❑ Adobe f] Fill Materialt`.Y.t �If yes,ty�___________________________ <br /> y. <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 seepa pit permitted if public sewer is available within 200 feet,) rr <br /> PACKAGE TREATMENT [ ] SEPTIC TANKft, Size_!__2._. - ?�._ 1 ........... Liquid Depth _._...................... <br /> J�6 <br /> Capacity Type rl EC - _ Material No. Compartments <br /> istance to nearest: Well .........43�. ..___.!Foundation __.1&4-�___.. Prop. Line..... r <br /> LEACHING LINE [ No. of Line's. ------________'..-Length of each line.-_- ----/4' T.otai• Length <br /> f .� <br /> _ t Ir <br /> 'D' Box ___ � �i'-4��De'pth•Fi•Iter Material _.__1... .................... <br /> _J�.S Type Filter Materi I�:.:..'_._.___..._- <br /> Distance to nearest: Well �"r Foundation :__fi�' '�--__ Property Line __,�_______________ <br /> SEEPAGE PIT Depth t± it <br /> [ ) p ____________________ Diameter '___._, _ Number __...__...0:_.___..__... Rock Filled. Yes ❑ No !U <br /> Water Table Depth ._:._.Rock Size A; <br /> .t �S <br /> Distance to nearest: Well ............... ................... <br /> ...Foundation,•_................__. Prop. Line ____-______.___._.___. <br /> J: <br /> REPAIR/ADDITION(Prev. Sanitation Permit#__.....- ........................?.._ Date ......... _...__________. <br /> Septic Tank (Specify RegC'j rementsY " ................-•-••••••- <br /> Disposal Field (Specify Requirements) ............. ...............i.... -;. f ---.... ....... ---•--•-••---•---_..... <br /> ,,F. <br /> 77- <br /> ................................................................................:_.._................__........-..._ ............•_................................ <br /> (Draw existing and required addition on-reverse side) <br /> I hereby certify that I have prepared this application and: that the Work will­bo done in accordance with Sari Joaquin <br /> County Ordinanses, State Laws, and Rules and Regultition's of the'Son 1Joaquin,tocal Health Di�triet. Homo owner er licen- <br /> sed agents signal certifies th allowing: :} <br /> "1 certify th tin e p on + of he work for which this permit is issued, I shall phot employ any person in',.such manner <br /> �r <br /> as to be e s - ject tt rk n' ompensati,on laws of.`California."J 1 ) <br /> Signed . ... --,.._.... __ ,. :............... .....•• ............................... Owher r2 , <br /> Br r�tle ----------------------------------------------------------- <br /> (if <br /> -.-.•-.-...--.•..------•---•------.-•--•---•--•------.-.-(If other than owner) .. , <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- <br /> ................................................ ......................... DATE ..._ .,_.:lj f~ ------- <br /> BUILDING PERMIT ISSUED_...._._ _•__........_ -------DATE-------------...............•,- .,........ <br /> ADDITIONAL COMMENTS . ..... . .... .................................... . ............................................-__._..................•_•---- . .._.... <br /> --------------------•- ••--------- ,� ......... •_... -------•-----_-•- -•----------•---•-•------•-•----.--------•--•-----•-•- -• -•-------- <br /> �.. _ <br /> Fina! I4spec-ta = ��r Q-,- - -•- - M �.. Dat y� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1-'6$ Rev. SM ..,k� <br />