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- FOR OFFICE USE: � FOR OFFICE USE: <br /> APPLICATION FOR S NITATION�PERMIT Permit No7- <br /> ..-_.-"------- ------- <br /> (Complete in Triplicate) <br /> ---------- <br /> - <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 herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: t <br /> 7 �/.1-1 CENSUS TRACT-------------=----------------- <br /> JOB ADDRESS/LOCATION.-- --- = ✓' � <br /> /_ /Zoz_.�e-)--- ------------------ ---- <br /> Owner's No ...........�!�.tQ����-----/L� �_G - ------ -------- Phone "." <br /> '? �/�% �''° !` '----------city...... -SG'r'9jG� -------------Zip-------- -- ------------------ <br /> Address------ ---,;- �----7 _- <br /> '4 S� -6 Phone&F <br /> Contractor's Name__------- .!9-tejel_e1� -Cf��- License # = <br /> Installation-will serve: Residence Apartment House.❑ Commercial ❑ .Trailer Court ❑ � i <br /> Motel ❑ ` Other----- ------------------------ --:----- - - r <br /> Number of living units.:-,-.---/----- Number of bedrooms------Garbage Grinder.-.----- -Lot Size-"". <br /> Private <br /> Water Supply: Public System and.name----------- ----- <br /> Character of soil'to a depth of 3 feet: Sand E] Silt El Clay El Peat F] Sandy Loam E] Clay Loam W� <br /> Hardpan ❑ . Adobe E] Fill Material l --_---------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.) y <br /> NEW INSTALLATI,P.N:..,., .(No septic tank.'orseepage pit permitted if public sewer is avallab a within 204 feet,J �r <br /> Size-;-- ----------- Liquid Depth.- <br /> B <br /> ty <br /> PACKAGE TREA7�}VIENT [ ] j SEPTIC TANK [:] -- " ""- <br /> t i ` <br /> 7 ------------------ <br /> Capaclty__/�-�---:TYPe-/"��'G�-----_Matenal_L�:��� -.G.--- o. Compartments <br /> �. <br /> t DistanceJo.nearest: Well--------.:. - --------------------Foundation----- '-�" --------"-.Prop. Line------- f1""___-""-.--- <br /> ---------------- <br /> LEACHING LINE, [ } No. of Lines.---_.",;,; ----- ----- Length of each kine."- -------. -.--.Total Length ""-_--" - 4 <br /> '.D' Box�'t�-f.._Type Filter Material-�------i-- <br /> -----------Depth Filter Material----------------�-:- <br /> ----;------ --- -r---- ------------- <br /> ne <br /> Distance,to nearest: Well---.3 L__,� � ------- -Foundation---�-if_-------------.Pro er� Li -�-- ------------- ----t: <br /> RockFilled Yes - No- <br /> ❑�i <br /> SEEPAGE PIT Depth.- l�� meter"� k.r---Number--------'�----- ------------ <br /> ------------------- <br /> ------------ <br /> A_Water Table'Depth-..-------- mm -----.Rock Size <br /> Distance to nearest: Weil--.----- .. - ----- <br /> Foundation."-- Prop. Line -- <br /> Se t;c Tank <br /> {Prev. Sanitation Permit#--------------- <br /> :Date ------------ <br /> ------------------------- <br /> Septic <br /> --------------J <br /> REPAIR/AD ---- ------ ----- -- --- ---- -------� ----- ---- ---- <br /> P (Specify Requirements) -------- ----------------------------------- <br /> ..---- - ..--- ---------- -------------------------------------------------- <br /> -------- <br /> Disposal F l,9(Spe f) Requirements)-__ ----- ----- ------------------------------ --------------------------------------------- ------------- <br /> - - _. <br /> = ----- ------� ------------------------------------------ ------------ <br /> i -------------- - - - ------=--------------------- <br /> - <br /> ' (Draw existing and required addition'on reverse side) <br /> I hereby certify that 14iave prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances,fState Lavvls, and 'Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify'that in the pekorMance 'of the work For which this permit is issued, 1 shall not employ any person in such manner as <br /> to become su 'ect to'Workman's Compensation laws of California.:'. <br /> Signed ----�Q -.��YJ�/�� --- ------- --Owner <br /> ' Title <br /> BY --------- <br /> (if <br /> - <br /> I <br /> ether than owner) ' <br /> } FOR-DEPAR T USE ONLY ' <br /> APPLICATION ACCEPTED BY. - ----------------------------- <br /> : <br /> ------------------ DATE. <br /> DIVISION OF LAND NUMBER------------------- -------------- <br /> -- <br /> DATE ------------------------------ ---------------- <br /> 4 .----"---------------- =------ --------- --- ---- -----.-- -------- --------- --------- -- ----- ------- --------- ------- --------- ---:- <br /> ADDITIONAL COMMENTS --� <br /> -- ---------------------------------- <br /> -------------- <br /> -- <br /> - ------------------------------------------------------- <br /> I - ----------------- <br /> -- ------------- -- <br /> ------------ <br /> D <br /> -- ----------------- -----------== ----------------------------------------------- ---- <br /> ------------------------------------------ 7 <br /> Final Inspection�b � ----�- - ------------------'� ---------- ---�_--- ------ <br /> -------------- ate j--------- �, <br /> - ---------------- - <br /> P y.-.---" - - F&S 21677 Ey./J6 3M <br /> Eli 13 24 SAN OAQUIN LOCAL HEALTH DISTRICT <br />