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ICOR OFFICE U5E` APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..� <br />....................................................... ------ <br /> (Cornpleto in Trlplicoto) <br />..................................................... Date Issued <br /> This Permit Expires 1 Year From Data Issued <br /> Application is hereby made to the San Joaquin local Health District for a permlt to con=tra ct 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/LOCATI ... ` .T.......�..... .............. ..`. .. f.............. CENSUS TRACT ........................ <br /> Owner's Name ..... .... ... ......./ ¢.y.............. ... ........ .Phone / .... r+ .............. <br /> Address ................ .. !f.:.... : `5!. .....E.Ity - ...... .... ... ,........ 7711 _ <br /> Contractor's Name .............. .rt . .. .. ............License t ZS.tf.- D..... Phone <br /> Installation•will•servo~-- •— -Residence•�fApartment House 0 Commercial oTraller Court-0 k <br /> Motel 0 Other............................................ ft <br /> its -..... •--- ...... x <br /> Number of living un ... `` . Number of bedrooms � Garbage Grind rt--__.... Lot Size .. �- <br /> Water Supply Public System and name ..._..----•- ,-----....r_..-... . ........... <br /> ............................ <br /> lrrlvtMe 0 . <br /> Character of soil to a depth of 9 feet: Sand 0 Silt 0 sClay-[) Peat 0 Sandy Loam 0 Clay Loam 0 <br /> -Hardpan[] —Adobe ..FIII.Materlal yes,type max...... ........ ............ <br /> v r• <br /> (Plot plan, showing size of lot, iooatlori#of>systern in relation to wells, buildings,, etc. must be placed on reverse side. <br /> NEW INSTALLATION: iNo septic tankar seepage pit permitted Jf public sewer is av:a0Pbte within 204 feet,l <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size.......:..........tk-.J, .__................. .... lquid Depth ................ ...... <br /> Capacity .. T ..........i. Material...................... No. Compartments ........--•-....---... <br /> Distance to nearest: Well ...........Foundation .......... Prop. Line -.----_------..----• <br /> LEACHING LINE ] No. of'Llnes .- --- .. Length of each llne':.:_.:.:" :..s_.._....... Total Length ........................... <br /> i <br /> 'D' Box ............ Type Filter Material '—!................Depth Filter Material ............................................ <br /> Distance to nearest: Well .......... ......... f=oundation ........................ Property Line ................ .. <br /> F • <br /> SEEPAGE PIT [ 9 Depth ... Diameter Number ....... Rock Filled Yet} 0 No <br /> Water Table Depth ................................................Rack Size .................... ........... <br /> Qistance b-naa�si: Wel! . _•� <br /> .................Foundation ......�............ Prop. Liras ..................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# .. .......................... e ....� . . . .. ...... <br /> Septic Tank (Specify Requirements) .......... -. . . . . --. ." <br /> Disposal Field (Specify Requirements) . .I.?41aC.J . ._... 7" C-r° ........................ <br /> •...................... .... � . ....................................... .. .�.......... .}.............--..................................... : ..................... <br /> �.} <br /> ' (Draw existing and required addition an reverse side) <br /> 1 hereby certify that I have prepared this application and'thof the work will ba done In accordance with Sara Joaquin <br /> County Ordinances, State Laws, acid Rules and Regulations of the San doaquln Local Health District. Horne owner of iiceft- <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the worts for which this permit Is Issued, 17slioll'not employ any person In such manner <br /> as to became subject to Workman's Compensation laws of:Catifernla" <br /> Signed ....... .............. ......... ................•....................... Owner �— <br /> $ ..... ... ........................................... Title _...:: :"-...................!............................ <br /> ... <br /> Of h r than owner) <br /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..------•- -• ._...----• .. ._. .. ........---••................................................ <br /> DATE ...... .. ...3.9.:...:........... <br /> _. <br /> BUILDING PERMIT ISSUED ......................... .............................•---....i............................ DATE ....... <br /> 1. ADDITIONAL COMMENTS -••....................................................,.........-.--....=....:..................... <br /> ....... <br /> ...................•-----..-_..........-•••--.....................---................... :... .:..:._.............:... ...-..-...-..:. .................................I................. <br /> ..................................... ................---...................--•-•--- ................................ ' <br /> ... ................................................i... ... ..........................I....._ �... -......-..-........... ...... �7h3M <br /> ........... <br /> i <br /> Final Inspection by: . .....---........:' -��10• Y .:.... �. ute .... .. ., <br /> EH 13 2 1-EiFi Nov. 5?4 SAN OAQUIN LOCAL HE. <br /> L D15 R <br />