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•� -.. FJR'DFFICE USE: y: <br /> -= APRLI.�A!JON ICOR SANITATION PERMIT <br /> .......................................... ._ <br /> ' (Complete in Triplicate) Permit No. ..........a....,...............­1_111.................... <br /> ---. - --:.------ & - This Permit Expires 1 Year From bate Issued Date Issued o�`. <br /> - ------.-1111.------ .. �-�. .. - <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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ' JOB ADDRESS/LOCATION ....L.tNljc...-R0, �'. / ' <br /> �-1 �..�i14�ic�lY�4----- - 1.111. . . . ... ................ . .....CENS[!S TRACT -............... <br /> Owner's Name ....... H-,r- <br /> -- tr StJ f?N.. %�C i IG ��14 ►J. Phone 4 III J-i.. '� .... <br /> Address ..... ..... X ...'A<.1 wT' - ------_----- City . <br /> --------------------•--•� -------.. . �m oaNE1"JC9__-'--------------1111.-------• -•- <br /> Contractor's Name ------------------_--- -- -------.-------------------License # .11 _ -- ------------. Phone -----•--- .................... <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel [`Other T.-............. <br /> Number of living units: I......: Number of bedrooms .-4------Garbage Grinder ..RQ.... Lot Size ............................................ <br /> Water Supply: Public System and name .-•----------------------------------------------------------------------_---- •---- -----------Private 2_� <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loans <br /> Hardpan ❑ Adobe ET'FIII 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 [ ] SEPTIC TANKw� Size.__.....---Z10U..___..__--..__........ Liquid Depth .-- -- ......... <br /> Capacity c�1400: --------- Type NE_*A----. Material_M1t-C4 .___ No. Compartments ...'1,............. <br /> Distance to nearest: -Well ..kn---- ------------1111..----Foundation _2 '._-=------ Prop. Lipe .............. <br /> LEACHING LINE [ j No. of Lines -------------- Length of each line......./QV------------- Total Length ..�a.d......:........ <br /> 'D' Box 's.._.__ Type Filter Material { =- r' ----Depth Filter Material ------4V-_------.-. . <br /> Zer line - -- - <br /> Distance to nearest: yy.oll ..__ ............. Fo ndation �'�� ------- Pro t ---1-s-0.1- <br /> SEEPAGE PIT [ ] Depth 1111---------------- Diameter ----.----------- Number ----------------------- ---- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size ------------..-..--------------- <br /> Distance to nearest: Well ----------------------------------------Foundation .-.----------------- Prop. line --_------ ..._..----- <br /> REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date ._------..----.111.1..............) <br /> SepticTank (Specify Requirements) ------------- --------------------------------------------------------------- ..............................__-----_-------_----- <br /> Disposal <br /> . _-..--_-..-..-..----.Disposal Field (Specify Requirements) ----•--------------------------------------------------------------- ----------------------------------- ----------------------•-•--- <br /> _ ..---- ............................•--- <br /> •---1111...--- -- - .-1111.--- - - ------------------ --- ---------- -- -------------- ----------- ---------•---•• -• --�- <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 beco e s bject to Workman's�CQmpensation laws of California." <br /> Sig �. ....+r Aj.r.^c c _�.!t•4. .<�? [1'--------- ---------- Owner <br /> �_. . <br /> o Title r'j�� ... .1L��. 7 !.SrQ .r..-.r....._...-.. <br /> By .. .......---.1111. <br /> (If other On owner) <br /> FOR DEPA TME T US ONLY <br /> APPLICATION ACCEPTED BY .. - 4 ./ .-..L. DATE- ........................ <br /> BUILDINGPERMIT. ISSUED ....11 11 - _... 1111. ...... .... ....... ... .. ..............DATE . .__.......------------------------------- <br /> ADDITIONAL COMMENTS ......--- ---------------------------_...._..- - --- ...----- -------- •• --..-.-. <br /> ------------ - ------------.........--------------------- --- <br /> -------.----- <br /> -------111.1. <br /> .._....--- }:� - --- .-i- <br /> ------ <br /> Final Inspection by. .............. ----- -•- <br /> SAN JOAQUIN LOCA ALTH DIST T <br /> k Q o.. 1_'AR R-v _5M <br />