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r-i.rK �r•r•�� �k <br /> APPLICATION ICOR SANITATION PERMIT 7/ 7Q <br /> ..................................................... ICotnplete In Tripllcahf Permit No. . <br /> . ... ' ... <br /> ............................. . .. . . . This Permit Expires t Year From Date Issued Date IN <br /> Issued <br />... . . I' .6. <br /> Apptieation is hereby made to the San Joaquin Local Health District for a permit to construdldh 4 wtQ4ork herein <br /> described. This application is made In compliance with County Or Inance No. SA9 and existing Rules and Regutations: <br /> .106 ADDRESS LOCATI h. � .. .. - .... .-....... CENSUS TRA .......................... <br /> S�. .. NS s cr <br /> Owner's Name . <br /> tom.. . ...............Phone .k.�.4.„���........ <br /> Address . .`� - -... �'./...r. . .........'City ............... <br /> 71 <br /> Contractor's Name ... .,. . .....................................License # . Phone _ :.. <br /> Installation <br /> will serve: slclenceApartment HouseiD Commercial❑Trailer Court 0 <br /> Mote!❑Other............................................ <br /> Number of living units:............ Number of bedrooms .ff....Garbage Grinder ............ Lot Size ............................................ <br /> WaterSupply: Public System and name ......................................._.,..................._................................................private <br /> Character of soil to a depth of 3 feet. Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam❑ <br /> Hardpan❑ Adobe❑ Fill Material............If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, ate. must be placed on reverse side. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) v <br /> PACKAGE TREATMENT ( ] SEPTIC TANK ] Size..... ......................................... Liquid Depth ......................... <br /> Capacity Jli ..._. Type • - ••-- - Material <br /> � ...................... No. Compartments -�--......... <br /> Distance to nearest: Well. ...... ...............Foundation ...................... Prop. Line ....... <br /> LEACHING LINE ( ] No. of Lines .'-9 Lengthof a ch 11 e....I/................. Tota! Length �/�.�......... <br /> 'D' Box .L........ Type Filter Materia! .. .. _ ....Depth Filter Material .r ........................... <br /> • <br /> Distance to nearest, Well ........................ oundation ........................ Property Line ...................... . <br /> SEEPAGE PIT [ ) Depth .................... Diameter ................ Number ..............-------------- Rock Filled Yes ❑ No <br /> WaterTable Depth .....•.............................•--..........Rock Size ................................ <br /> ` Distance to nearest: Well ..............Foundation ....... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> SepticTank (Specify Requirements) .........................---.......••--- ---•--•--....................................................,............._................_ <br /> DisposalField tSpecify Requirements) ..............._................----............................................................._................................... <br /> ....-------•--••...............•--------•-•----••-----•----...--------•--•---- .............................-............................................................................................ <br /> f Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be dons In accordance with San loagatn <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hama owner or Ilcen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, I shelf not employ any person In such manner <br /> as to become subject to orkman's ompensation laws of California" <br /> Signed ... ----�f.... Owner <br /> ' .................... 7itle ........................................................................ <br /> 6y .............................................•---- ............................... <br /> {If other than owner) <br /> 9= FOIR D PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. .:.. _....-. ...................... DATE ... <br /> BUILDINGPERMITISSUED...........................................................................................................DATE ......................................••... <br /> ADDITIONALCOMMENTS --.......---•-.........--•--•..............................:........................... <br /> ........................................... ................................................................ .�..__........................... ...-........-....................................... <br /> ............... .......... <br /> .............. ............. ........ <br /> Final inspection by: ----.. ... <br /> .......I Date ... '��. . ........ <br /> EH 13 2!t 1-68 Rev. AN JOAQUIN LOCAL HEALTH DISTRICT /?t, <br />