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i FOR OFFICE USE: II <br /> Il �, - -PLICATION FOR SANITATION PERMITPermit No: .7�?. -6 <br /> ...........................•------- .......... <br /> (Complete in Triplicate) .,- <br /> ..........................•- - Date Issued <br /> This Permit(Expires i Year From Date Issued f <br /> ..................................................... ti <br /> �l <br /> Application is hereby made to the San Joaquin Local Health.District for a permit to construct and install the work herein <br /> desoribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ' <br /> 2 1b all Drive .. -------------CENSUS TRACT -- _:... <br /> JOB ADDRESS/LOCATION!...........�...:.�.__ .'--_� ---•- .-_.... <br /> . 3502 <br /> Owner's Name ! •---••-------------- ..------. :.. .-:-------.._...P one . .... <br /> ...................E.... <br /> Cit -T�%cy.----•---•- --------------------­------ <br /> Address .- <br /> _.. <br /> e5 <br /> Contractor's Name-.•- � ..-----.License # ....99-94 Phone . <br /> Installation will serve: Residence$]Apartment House] Commercial o. Trailer Court ID <br /> in units:_.;_.-_ Number of bedrooms -----_._---. �arbage Grinder -----------: Lot Size .-.....-�............... <br /> Motel []Other__ ........................................ <br /> 0 g1� ..._.._... -•--•_.... <br /> Number of living <br /> Water Supply: Public System and name -------------------------------------------------------- Private <br /> Peat Sand Loam Clay'Loam. <br /> Character of soil to a depth of 3 feet: Sand j] Silt[J Clay ❑ ❑ Y t7 r ` <br /> Hardpan Q Adobe•0 Fill Material ------------If Yes,type---------------_•_---------- 1 <br /> I Location of system in relation to-wells, buildings, etc. must_be,placed,on reverse side.l <br /> (Plot plan, showing sizeof lota <br /> y � � _ y _ _ - <br /> NEW INSTALLATION'i '''(No-septic tank or seepage pit permitted If public sewer is available within 200 feet,) i r <br /> ..r- ti uld De th ._...., ..._.......... <br /> PACKAGE TREATMENT ,[��, SEPTIC I ' ' Size_'..;Y------------------------------------- <br /> _. - q p <br /> .. �. t -�. ._.... <br /> Capacity ___•Type .^' - • Material�................... No.. Compartments <br /> ( <br /> t -- ...-..... _ <br /> bistonM to nearest: Well ..5---------- -------Foundation Prop. Line _.___-.---:-.:.:_-_-•- <br /> LEACHING LINE, 13 No. of Lines -._-__................. Length-of eaciih line__.,.._._.-__-----•-,_..... Total Length ,_......,._._._.,_ _....._. <br /> 'D' box .---....._-- Type Filter Material..........Z..___....Deptt, Filter Material__---------------•---- =- <br /> F <br /> Pia --- <br /> o e` Lm <br /> gistance_ to nearest: Well .............:........:_ Foundation _.._._-..; p rty <br /> SEEPAGE PIT [1] Depth Diameter ................ Number __._.._....:�'...-_._.._.... Rock Filled Yes Q No iQ <br /> Water Table Depth ----•--•-----------------•----------- Rock Size ..::.._.... �•• - <br /> 11 <br /> Distance to nearest: Well ....................---------j---------Foundation _..----.....---.-•-- Prop. Line ---------............ <br /> 11 p <br /> ..........._'`•Date .-- = <br /> REPAIR/ADDITION(Prev..Sanitation Permit# --............ <br /> Septic Tank (Specify Riquirements) '------ - ..s....BJ� ] <br /> ') 100 13.n _ ...... PPlezit is <br /> Disposal Field (Specify Requirements) ......................... -._2.:._wills._-lea� ,_ig_..a�r ,�,>�.. .__ <br /> raanaa li ...........••---------------•---------••........__.....------------------- -.._....... .........._ <br /> i +_. -------------------------- -- - <br /> j....................• -••------...I�---•--•-•......._._......._.......__._....-._.__...._.--•--_._._....-_ --..._._---..__...___ e)_.-. <br /> (Draw existing and required addition on reverse side) [ <br /> I hereby certify that I have prepared this application and that the work will be dont: in accordance with San Joaquin <br /> quin Local Health District. Home owner or'licen- <br /> County Ordinances, State Laws, and. Rules and Regulations of the San Jou <br /> sed agents signaiure certifies the following: <br /> "1-certify that in•the•'p®rfbrrna o t 'woik fog which'this—ermit•is issued, I shall'not employ any person in such ma nn*r t <br /> Cis to become subject to Wor man's Co ens n of Iifor Ia." <br /> PgiT,iai U'IS�-.PL ....ING --- - �-- ••.. <br /> Signed ...... �.. <br /> ' ----- itle .......Ma-nag_T-----------------------------••- <br /> I <br /> (If other than own <br /> FOR DEP Att ENT USE.ONLY i <br /> 1,.. ',<!l1,... DATE ..... - �0-{t?•••-••.-•-----•--- <br /> APPLICATION ACCEPTED BY ......--...-•--- ............................. _ .-DATE _....•---------------•--• -------•••-----• <br /> BUILDING PERMIT ISSUED ......... -••--......-------------- ------- ------ •.......... . <br /> ADDITIONAL COMMENTS <br /> ..---•-- <br /> . -- -- <br /> �;= f�`'�r► . ---.....--- <br /> Final Inspection by: .-•_...Date ' .. <br /> 1- <br /> II SAN JOAQUIN LOCAL HEALTH DI RICT <br /> c to 0 1.'AA RPv. SM <br />