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rVX... irrI%X vbe APPLICATION holt SANITATION PERMIT <br /> "` '` =� +1 Permit No. ..7 .........5- <br /> - (Complete In Triplicate) <br /> ..... ............................................ This Permit Expires 1 Year From Date Issued Date Issued I. <br /> Application is hereby mads 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 Regulationst <br /> IRV <br /> JOB ADDRESSAOCAT( N ......B...................... . ...f �J -......: CENSUS TRACT <br /> Owner's Name ...----. '��r �.. .. !........... .... ... r_............ .,. ......... ...... .....Phone ............ <br /> E%ddress ... . -•.............. . ..........................City ...wiz ! A! ...--- ...---..... .......... <br /> V__-�2 <br /> Contractor's Nam® -�-- Phone ... fl.. <br /> '= � °: license .. ?.....rte........_ <br /> Installation will serves Residence OAportment House JE] Commercial{]Trailer Court 0 <br /> Motel 0 Other <br /> Number of living units:...... ... Number of bedrooms .3------Garbage Grinder tot Size b 7 X <br /> Water Supply: Public System and name -------••........................----•----..---......_.........-.........._........._..---...............Private <br /> Character of soil to a depth of 3 feet: Sand b Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay loam 0 <br /> Hardpan 0 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 an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) r <br /> PACKAGE TREATMENT [ ] SEPTIC TANKt4 5 ze_.. _� :�....................... Liquid Depth .... .Y .�........... <br /> Ic � � <br /> Capacity (-.43 .._.... Type ..°........ ........ Material.. �:.�... No. Compartments -------------------., <br /> r <br /> Distance to nearest: Well ,_. Q:r,� 7.................Foundation t ... Prop. line �'� <br /> r. <br /> --... _0 ...... ...............•--•. <br /> �EACHING LINE No. of Lines <br /> ..... �.......... length of .each line...... ................ Total length ...LZ.V................ <br /> ............... .Box Type Filter Material . Depth Filter Material ..... <br /> �. ... E. <br /> D' <br /> - , Distance to nearest. Well ....14 �. ` ... Foundation _..../..o.r� ...... Property Line . ......... <br /> SEEPAGE PIT Depth .... Diameter .23....... Number ...._.............. ........ Rock Filled Yes No <br /> Water Table Depth ................................................Rock Size Jxy= - � �••-.._.. <br /> Distance to nearest: Well .a:......................Foundation �'� '.. Prop. line ....` ...''� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ......................:..................... Date ..................................I <br /> .peptic Tank (Specify Requirements) ........................................... .............................................................................................. <br /> Disoosal Field (Specify Requirements) ................................ <br /> -----------------------•----------------....---.....-----•------------•---•-------------•-----........_.................................._....-----•------•-----•-----..............-•---.......... <br /> (Draw existing and required addition on reverse side) <br /> I hereby cartify that I have prepared this application and that the work will be done In accordance with San Joaquin i <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Homo owner of 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 /> r <br /> avec .... ....... ........ - ----......�.�....�..t� ...............................�caner <br /> _ <br /> BY ... `......v itle <br /> (If other. h n owner) <br /> FOR DEPARTMENT USE ONLY 7 <br /> APPLICATION ACCEPTED i3Y . ..... DATE .. !-- .•r• '.•:�' f�' <br /> BUILDING PERMIT ISSUED DATE-...-. <br /> ................. ....---..... <br /> ADDITIONAL COMMENTS .. ... ............ ........•-------........................ .. <br /> E ----..-----•------- -•. ............................... <br /> ...... ........ <br /> ----- - ------ -- - ------------- ---------- .� <br /> Final Ins ection b -------------••---..... .. Date .. .- .. ... ................. <br /> 13 2L 1-bh Irv, 5�i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> I <br /> k <br />