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,- FOR OFFICE USE: APPLICATION FOR SAITATION PERMIT <br /> ------------- - <br /> ������ ---------- Permit No,.. <br /> �� -.--.""""-""--------""""" {Complete in Triplicate] <br /> ------------- ---------- /f <br /> Date Issued <br /> " " ----------------------_------------- -------------- + This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereir, <br /> described. This application is made in compliance with Cou y Ordinance No. 549 and existing Rules and Regulations: <br /> JOB AQQRES5/LOCATIOIL C7—C7 �- --------`r _ 6 /'Y.t ENSUS TRACT ----------------- <br /> ---------- <br /> Owner's Name y ZZ <br /> �=a Y� -----,-/-------------------------------- - - -- Phone7""/_"" - f <br /> Address ------------7-1."/?--- Pi't ---- ----------Gy/f-'------------------. City <br /> s" -_-- License #a2-I�'.71*7-7--- Phone <br /> Contractor's Name ." . "".""..-"___-<�d----. ^�"----� - <br /> Installation will serve: ResidenceVApartment House❑ Commercial ❑Trailer Court <br /> Motel ❑Other -------------------------------------------- <br /> Number <br /> ----------------------- ------------ ---- <br /> Number of living units:--- Number of bedrooms �-------Garbage Grinder `71-F lot Size ___ _____-_1 <br /> Water Supply: Public System and name ----0ar------- -----------------------------------"---------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay. ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ II <br /> Hardpan ❑ Adobe ' Fill Material ------------ If yes,type ----------------------_-_-- lw� <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must .be placed on reverse side.) v` <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ 1 SEPTIC TANK[ 1,eY(IS7 /;&1Cze----------------------------------.- ---------- Liquid Depth --:------------------.----- <br /> CapacitY -------------------- Type ---- - ------------- Material----------- No. Compartments ---------------------- <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line _--_-_-- :-,_--__. <br /> LEACHING LINE �r' No. of Lines -- ---- Length of each line_____�Cl'------_------ Total Length ,-�"�_�__-_--_-_-- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- <br /> Distance to nearest: Well ", Foundation ----lA_f-_------- Property Line. -"" �.__.--._-.-_ <br /> SEEPAGE PIT Depth -,JX---------- Diameter _-��"� Number -------/.---__-__.-----_ Rock Filled Yes � No i❑ <br /> 10 <br /> �r <br /> Water Table Depth -------96 ------Rock Size ------------- -- <br /> Distance to nearest: Well ".". "--" ---_--__Foundation .---/ "r"_"" Prop. Line --- � -----__-_. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------•------------------------------------ Date ---------------------.----.-------) <br /> Septic Tank {Specify Requirements) --------------- - -- ------------- ---------------------------- <br /> ------------- - ---- - --------- ---------- ----------------- <br /> Disposal Field (Specify Requirements) ---------�Q----------Ga"'' '` ---- -- --------------------------------- <br /> ------------------ -----------------------------------------•------------------------ <br /> ------------------------------- -------------------- - -------------------------------------------------------------------------------------------------- ---------------------------------------------- <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 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 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 /> Signed ------------- - -----------. Owner <br /> = Title l -- ------- ---------------------------- <br /> --------- <br /> BY �""-� - <br /> (if other than owner) <br /> a FOR DEPARTMENT USE ONLY <br /> • APPLICATION ACCEPTED BY ---------------------------- ---------------------------------------- DATE -----3-10�---------------------------- <br /> BULLDINGPERMIT ISSUED ----- ----------------------------------------------------------------- ---------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------•--I---------------------------------------------------------------=--------------------------- <br /> ----------=----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- --- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---- <br /> ------- ---- - - ------- ---- <br /> ----------------------------- <br /> --- --------- ------- <br /> ---------------------------------------------------------------------------- ---------- ------- <br /> --- --- --- - ---- <br /> Final Inspection bY: - -------- - - •--- ---- Date '.�� f 3 <br /> '1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />