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rw►a a.rrY1�1.IC Y1'J�t , <br /> ... �:.. .� I APPLICATION FOR SANITATION PERMIT <br /> ......... •............ .. <br /> ....................... II (Complete In Trlpllcate) Permfpermit <br /> ............ ......•• ...................... I . This Permit Expires ! Year From Date Issued Data Issued `V <br /> A <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 mad�ej In compliance with County Ordinance No. 549 and existing Rules and Regulationsa <br /> JOB ADDRESS/L" TION; T,�. .. . ...; a . ....y,,.... CENSUS TRACT <br /> ...................... <br /> ' Owner's NameZo7• . ................... ....'....... . 0..- . ... <br /> . . .............Phone <br /> Address .................. . ._. . <br /> Contractor's Name . .�.:� - �---•--•............................---- .-.. ..�:..................................................._ <br /> .....:.............................................License <br /> d` .. .. �. ... Phone s? .. .✓. ... <br /> " Installation will serve: Residence g3lAp artment House❑ Commercial❑Troller Court (3 <br /> Motel F <br /> ❑Other---...--•................................... . <br /> Number of living unitst_. :' ..__ Number of bedrooms .��..-......Garbage Grlr�derF ..____..... Lot Sine <br /> Water Supply: Public Systeih and name ..................•......--•-__»..._..::...:: . . -•..--..............-----.Q......_.... <br /> ii - _. •• .... ......_......................-.......:..........Private <br /> Character of soil to a depth,of 3 feet. Sand Ll Silt[) Clay Q Peat❑ Sandy Loam ❑ Clary loam 0' <br />' Hardpan® Adobe❑ Fill Materlaf........ 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 INSTALLATIONa �! <br /> (Na septic tank or seepage pit permitted If.public sewer is available within 200 feet;( <br /> PACKAGE TREATMENT [ ]I SEPTIC TANK; 7 Size.................... <br /> •....:....... .............. Liquid Depth .......................... <br /> Capacity ° <br /> ••--•............... TYI� -------•............ Material.......:.....,__,..... No. Compartments. ----..... ....�' <br /> i <br /> Distance to nearest: Well ......Foundation . .. ... <br /> ' ........................••---• Prop. tine ................... <br /> N. <br /> LEACHING LINE { No of Linea I.�._ ----____t. .tength=.ofearh line....: _�............ f�.�......... s <br /> - Tota! Length <br />} ;18ox _.f..�.. Type Filter Material ._.._..Depth Filter Material .� .................................... <br /> � <br /> Distance to nearest: Well <br /> .....................•Foundation ........ ................ Property tine ................ <br /> SEEPAGE PIT .._.�' ��.- � <br /> [ Depth ...... Diameter . . . Number.... <br /> ... <br /> –�—�-- Rock Filled Yes <br /> Water Table Depth I <br /> ...:............•M: _.........Reck Size ............. ---......----...... No <br /> Distance to nearest: Well .....................::...............Foundation .................... Prop. Line ................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................................. ....... <br /> _._....._ Date 4 <br /> Septic Tank jSpecify #tequirementsl ............. _...........•-_....... .- . ......................... ......: i <br /> Disposal Field (Specify RIequirements) ... .� - ._ .... ........ <br /> ..............................................66 ...........-._........_.............._....____....k........_....................... .. .... <br />' ....................................4-... .� 1! � !I <br /> ... ................. <br /> .............................-................................................................................... <br /> ..:...... <br /> Draw existing and required addition on reverse side) <br /> I hereby cerci 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 R69ulations of the San Joaquin Local Health Distrlct. Homeowner or lice <br /> n• <br /> sed agents signature certifies the followings <br /> "I certify that in the performance of the work for 41ch this permit Is Issued, I shall not employ any person In such manner <br /> as to become subject to Wor'kman's Compensatlori laii s of California.°" <br /> Slgned ._.[. -- , <br /> ��// �� Owner :48 SY .....................!............ --- --- Title .................... . -----_.. ._ <br /> If other than owner( <br /> li <br /> FOR DEPARTMENT, USE ONLY <br /> APPLICATION ACCELN <br /> Y ..... DATE <br /> BUILDING PERMIT <br /> AQpITfO TE :.. <br /> • L CQ t.._ <br /> .....................................'�.............................................-.........-................................. ..:.......... ........ ......................... <br /> Final inspection by:. . .. �.._ A�7 ....................... .......... .....•..............----•---Date .C–: .:. . ...........-. <br /> EH 13 24 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />