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FOR OFFICE USE: y <br /> APP1,ICl�.!!3d FOR SANITATION PERMIT . <br /> (Complete in Triplicate) <br /> Permit No. .7 <br /> - :..........................•••........ .. <br />-.- .........................................I......... This Permit Expires ] Year From Date 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION...... � .c2�.� � -------- x06. ..-CEN SUS TRACT .................. <br /> Owner's Name ---A�5-.K..... � .1_ Phone ._. <br /> ------ ........•••......... . ....•-••-•--. ....•.........._..._ ... ......... .......... ---•-- <br /> -----.-.. City _ 'rfA .................. <br /> Address --------*.�G�'.�.�---------------------•---...__.�--....................._ --�•---._...-----...__..-----... <br /> Contractor's Name ...._._,/ �-,r ._9- _/eaL?17i,17....................,........License # .. Phone <br /> Installation will serve: Residence ❑ Apartment House Commercial ❑Trailer Qvort <br /> Motel ❑Other ....................................... •--- <br /> Number of living units:__./.... Number of bedrooms ---A___-Garbage Grinder ./I _ Lot Size .A*&G,AC - ................ <br /> Water Supply: Public System and name ----•- -------•-----------------••---•--••---- ---------.....................................................Private,, <br /> Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> Hardpan Adobe ❑ Fill Material ------------ If yes,type ...................... <br /> (Plot Ian showing size of lot, location of. system in relation to w `- <br /> P � ells, 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 /> ` <br /> PACKAGE TREATMENT [ SEPTIC TANK:Y' Size---f�- . 'r— --%................... Liquid Depth . .. ............I....... <br /> Capacity lZe4L.--. Type/,vm �?.. Material_ �,�d'.:_.... No. Compartments --1r................w <br /> Distance to n .`'nearest: Well ...... ...................Foundation ..-F____--._. Prop. Line ..1 ?..`.........N <br /> LEACHING LINE No. of Lines ._Z--------------- Len th of each line. ._,4e........... . Total Length fQ` <br /> g ,/� . g ....................... <br /> 'D' Box , __ Type Filter MaterialDepth Filter Material _ .................................. <br /> Distance to nearest: Well ............. Foundation ./' Property Line <br /> SEEPAGE PIT Depth _._04U..�..... Diameter _, .._.. Number,.___.f.............__. Rock Filled Yes)2' No <br /> CIA <br /> Water Table Depth ----------,� ......................... ..Rock Size ...... 1 <br /> Distance to nearest: Well ._..- p....................Foundation *...--_-,- Prop. Line Z.4e......... <br /> REPAIR/ADDITION(Prev. Sanitation'Permit s# ............................................ Date ..................................) <br /> Septic Tank (Specify Requirements) --------------------•------------------------- ..........................................•-............:.........._....__................ <br /> 1b <br /> Disposal Field (Specify Requirements) ................•-----------•-••--------------------------- •---••••••. ------- --------------•---...._..._-_-•---- -•------- - <br /> ., t <br /> --------------------------••-•................................................--------------------------------- <br /> -_-.---.-..-.--------------......-------------------------------------...._-------- -----------------------------------------------••--•-•---•-----------------------------------................ <br /> ....__. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have preparedlthis 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 /> BY ...__. ....---- ; .... Title .. 7 ....... <br /> (I er than owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY .......................................................................•----------.................. DATE .....I......... ........................... <br /> BUILDINGPERMIT ISSUED .................................................................................................` .....••..DATE ,.......................................... <br /> ADDITIONAL-COMMENTS ................._2.'................. ............._....... <br /> .._._......._._,....._................._........._....- - - ..... <br /> }. <br /> - <br /> ............................................--••-..° .. ..._...._.__ ........__._..__... <br /> ......................................................:.:..........._"JOAQUIN <br /> Final Inspection by: ............ � ----- ................ <br /> :..Y.......................-••---Date ,�.--.7..�Tf�._... --•------- <br /> SCAL' HEALTH DISTRICT <br /> E. H_13 24 1.-AA Rpu_ 5M 7/79 '3 H <br />