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FOR OFFICe USES <br /> .. APPLICATION ICOR SANITATION PERMIT <br /> ..,:..........::,. nl . ..:7. - sly <br /> ,..;:.....:.. . . .........�:...:.... )complete in Triplicate) .. Permit ......... .. <br /> This Permit fxpinm 1 Year fromDaM Issued Date Issued <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 incompliance with County Ordinance. No. 549 and existing.Rules and Regulatla" <br /> JOB ADDRESS/LOCATION 4,010.E Fremont <br /> Owner's Name ... Dora...E,. ScYi9T.der ScYi9T.NF............................................. <br /> ........................... TRACT .......... .:.... <br /> Address ... .!}.O10...E.:..-Fremont.................................................... ................. ...........:........Phone ............. ......:......,:,....,. <br /> Contractor's'Nome ..:.."ROTO- ROOTER SEWER SER............. . .. City .........:S:LQ�33toi�, __..... <br /> .. ...................................Uoen:e,l ..�•#(�7�5ior,e ..�!-�5-2616 "' <br /> Installation will serve: Residence A artment House Com ...^...^ <br /> [� P fl merdat E]Tralker Court 0 <br /> Motel <br /> Number of living units:.:! s Number of bQed�roior mser --..•• .......:.......:......:... ' <br /> ...3....Garbage Grinder <br /> Wager Public .........:...... .....: <br /> �PpIY� System and name ::.,.fie al f: Wat e r••Ser. <br /> .......: .,.......,...... ......:.....:.........Prlvcstsl . <br /> Q <br /> Character of tall to a depth of 3 feet, Sand 13. Silt C3 Clay. p Peat[]..- Sortdy loam O 'Clay Loom <br /> 0 ; <br /> Hardpan❑ Adobe fl Fill Matertat,aP.,...,.ff <br /> ...:............... " <br /> (Plot plan, showing siaio of 'lot, location of system in relation to wells, buiidings, etc, rust be p1med on rime slde.I <br /> NEW INSTALLATIONi (No septic tank or seepage pit permitted if public Uwer its available within 200 feet) <br /> PACKAGE TREATMENT 11 SEPTIC TANK( } Sin...........».... .... Ugv[d Depth <br /> .. :....: ........ <br /> Capacity .................... Type ............... MateNctt..... No. CompartnronN ...: <br /> Distance.to nearest: Well .... ........... .Foundation . :. . Prop.line``„ y'""j ... .. <br /> LEACHING LINE E.1 No. i f tines_............... ` tangth'of 'each 11 ` ......................_ ... � �h .•..»......� <br /> ..:.:.. rre -- Total .... .... .. <br /> 'D' Box Type Filter Material .........:..:.......Depth filter Material .................. <br /> Distance to nearest, Well ... Foundation Property Line ..:...................»p <br /> SEEPAGE PIT [ } Dep* ................._. Diameter - ............ N ' <br /> Nucabar _:........, :.:..... !tack Filled Ya: <br /> 6.�� Water Table Depth .................................................IEock ............................ fl � fl <br /> 'Distance to nearest: Welt ......:........ ....._:.............Foundation... ......... .... Prop. Line ......::...»... <br /> REPAIR/ADDITION(Prev. Sanitation Permit ala clue : . •l <br /> Septic Tank (Speeify,Requirementsl._.................. . 1lrM.»:..:....... <br /> ria-a:.•:�, •• t -....... <br /> Disposal Field (Specify Requirements) ................................ <br /> ................................................. .`". <br /> ...........:.......... ................ <br /> ..........._.........................I .. ....... -...... ....:.. ....., .....................:..... .. <br /> ............. <br /> {Draw existing and required addition on reverse sidel" . ............. <br /> 1 hereby certify that 1 have prepared this application and that;Ike wo& will bo i[orio In aecard ince with`Son.,legt ifl <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin local ReaWalsidd. No" owner or lipw <br /> sod agents:signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is lssi eel, 1 shalt scat anploy^'any person in fWA:onaniaw <br /> as to beta e s blect to Workman's mpensolion laws of California." , <br /> Signed ..... ............. .......... ..................................... Owner . <br /> BY .............. . ... ... .. Title _...... � . <br /> - - .......--- <br /> other than Hari •- brit"r�:i✓'Ct��............... . <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APP 10 10 ACCEPTED .................... .. ....... DATE -�.11 ,1 <br /> G[Y. <br /> RUILDING ERMIT ISSUED .......... <br /> ..:...... .. ..... <br /> DATE . <br /> ADDITIONAL COMMENTS ----- -------------- <br /> _ ..._...... .... . .. -........_.. ".......:.......i• ......._ , ................... ......... ....... ...._------.._ .... ---- " <br /> ........................... <br /> ................................... <br /> j. <br /> Final Inspection by .. •.....................:'..1,/d�--r�--_�lA.- ......................... <br /> EH <br /> 13 2 1-6 i�v• SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> - $/A, 3M <br />