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} <br /> „FOR:OFFICE USE: 3 ApPLICATi�DN` R SANITAT10nRMIT Z <br /> Permit No. <br /> - - ---------- r-�--��- 1'•---- -- -- .---------- � <br /> f `��� (Complete in Triplicate) <br /> --------=--------------------------- ------ _----------- <br /> Date Issued -- --- -:---__-• <br /> _-_-_----__--_ This Permit)Expires 1 Year From Date Issued <br /> __ i <br /> Application is hereby made to the San Joaquin Local Health District%for a permit to` construct and install the work herein 4 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO �-4f- - ---- -- ,-- `--1 <br /> -------------------------CENSUS TRACT ••--------- <br /> Owner's Name -------------------- --- ------Phone 3-"3-7a <br /> ------------- --- ---------- - - ----------------- <br /> Address , -------- --`' " -- ��Y 1 -*------•--• City ----------------------------------- <br /> c- off r <br /> Contractor's Name ai-Sec.. f �--------License # _G-. ��------ Phone -!�P.b_� ..--- <br /> Installation will serve: �sidence ❑ Apart nt, use,❑ Commercial Trai a ourt ',❑ <br /> -Motel ❑ Oth �r4�4?i�------------- �-•---- / � �`�j� <br /> Number of living units:---�---- Nurnber:of.bedrooms .___ __.__--Garbage Grinder ------------ Lot Size __________ __________________vim►IIS <br /> Water Supply: Public System and.name - - -------- --------------- -••------------- - -------------•--------•------------ <br /> ----------- --•--------Private S ; <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ . Clay ❑ Peat� Sandy Loam '❑ Clay Loam`$ <br /> a x <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 Y SEPTIC TANK:[ ] Size-------- _ ------------------------ Liquid Depth __-_.lr --_-__----- <br /> C") 7.00 Cry r Capacity;2qW1570L TypeMaterial__ '___ No. Compartments ----3............ i <br /> fjr.+I� Distance to nearest: Well ------------------------------------Foundation 1_4... ........ Prop. Line --- •�- ----__--� <br /> v , -------•-•.f <br /> LEACHING LINE [ j No. of Lines '__.__�---_____._-__ Length of each line------/.0Q_____._____. Total Length ._/0.0______ <br /> rr <br /> e L- ,��u 'D' Box _ -✓ Type Filter Material ._ ---___Depth Filter Material ------/.&_ ___.........__________________ ISI <br /> �C�yi� t�p� Distance to nearest: Well ------------------------ Foundation ____/A__�----__- Property Line _�__.-..-__-_--.--__ <br /> SEEPAGE PIT [ ] Depth __.------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> WaterTable`,Depth ------------------------------------------------Rock Size -------------------------------- <br /> amfoQP Dis#once to nearest: Well ________________________________________Foundation _."_:►_;=4 Prop. Line _._._______._.__-_._-. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .--_---_.__------------------ ------------------------' <br /> Date - --------1 <br /> SepticTank (Specify Requirements) ....s---------------------------------------------------------------------------------------------------------- . •---------------•----------- <br /> Disposal Field (Specify Requiremen#s)__---------_ - ' i <br /> ----------------------- <br /> ` ----------------------------------------- <br /> .. _ _ ----------------------------------------------------------- <br /> - <br /> {; <br /> (Draw existing and requiredaddition on reverse:side) <br /> I 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.inIthe perform�eince' of tltie work for which this permit is issued, I shall not employ any person in such manner <br /> as to become s'ubiect to Workman's Compensation laws of California." <br /> Signed --------------------- Owner <br /> c <br /> BY = Title ------cz�- t-------- --------=--------------------- <br /> ther than owndfl­ <br /> F05 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------- DATE _ '�— _ <br /> E ---- ------------•- ------------------------ <br /> BUILDING PERMIT ISSUED -- ----- - - --- --- - ---- --------------- DATE ---- - <br /> ADDITIONAL COMMENTS d <ec(<-� -, --= -,- -- �� <br /> -----------------------------------------------------�-- ------------------------------------- ---- -- <br /> ---- -- --- ------ ------: ---------- --- ------ ----------------------------------------------- <br /> --------- - --- <br /> i _ ------------------------- -- -•-=------- <br /> ---------------- ----- ----- <br /> Final Inspection by: �� = ----.Date --- / 7 <br /> -w SAN JOAQUIN LOCAL HEALTH DISTRICT, <br />! r N 0 1_,6A RPv_ SM <br />