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f <br /> FOR OFFICE USE: <br /> . PPLICATION FOR SANITATION PERmIT '�rl�� <br /> (Complete in Triplicate) Permit No. . ................ <br /> _.. . ... This Permit Expires 1 Year From Date Issued <br /> Date Issued . .�/ 'w <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/LOC ION / 1p�w /.. IV I�!'4A;t ,.Z `,G /�plc h CENSUS TRACT ....... ... ..._ ....... <br /> Owner's Name ,pOL672 ... ......._..._) / ..... _/_.. _.. Phone ............ ...... ................ <br /> Address `� /%�� day I Lc:c:.t aZ.Z _ ... ..... City L .'',?2 e h .�_.. LTi.. <br /> Contractor's Name �- �`• [��Zu�c� is(� � '��.�.Z <br /> . License #:.� 7`fv17/ . Phone .. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial RTrailer Court ❑ <br /> Motel ❑ Others;�'Cl/. SJ/?,3c_t� . a <br /> Number of living units: Number of bedrooms arbage Grinder Lot Size Lj 4lC,ee;S.............. . <br /> Water Supply: Public System and name PK _..._ ...... ._.Private <br /> Character of soil to a depth of 3 feet: Sand [] Silt ❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ 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 [ I SEPTIC TANK ( ; Size.. /L 1.../!..U Liquid Depth J—&,/ <br /> .............. <br /> Capacity�i�v''J Type/ -:5-4_ Material. - -� No. Compartments ...2--..........-/!,.w <br /> Distance to nearest: Well jFoundation o.`�—v Prop. Line <br /> LEACHING LINE ( ) No. of Lines Length of <br /> eachline S�S 1 Total /Length <br /> ,r, F�v_... Depth Filter Material �'D' Box Type Filter Material� . �'v_ �. ... .....�S <br /> Distance to nearest: Well $f� I .. . . Foundation �� JI Property Line.. ./a4..........._. <br /> SEEPAGE PIT ( ] Depth Diameter . -�. Number <br /> Rock Filled Yes 0----No <br /> Water Table Depth .Ise <br /> ............Rock Size <br /> Distance to nearest: Well IbO .. . ................Foundation s Prop. Line �� <br /> REPAIR/ADDITION (Prev. Sanitation Permit# . .. _. Date <br /> I <br /> Septic Tank (Specify Requirements) _ ... . ... <br /> Disposal Field (Specify Requirements) .. . <br /> 6 <br /> .. .... ..... <br /> (Draw existing and required addition on reverse side) <br /> 1 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 _ . ....... ------ <br /> Owner <br /> BY r _ Title . <br /> "let than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY /i� �`� DATE <br /> BUILDING PERMIT ISSUED ! DATE <br /> ADDITIONAL COALMENTS <br /> Final Inspection by: ... . .. ._...... .... .. ..... .... _....... ._ ......... ........Date � -.�,_ .. . . <br /> SADA JOAQUIN LOCAL HEALTH DISTRICT <br />