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FOR OFFICE USE: } <br /> - APPLICATION FOR SANITATION PERMIT <br /> - Permit No. ...7 ."....�.. 5qq <br /> (Complete in Triplicate <br /> 1 <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 <br /> described. This application is made in Compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Ll <br /> JOB ADDRESS/LOCATION tRSrO ...$1'Ic-° /J 9..M._.._m]...Al _R .. K�.foS0_. .CENSUS TRACT .. . <br /> Owner's Name 1't H. 7q. .b�2rh 11 -W..I...... Phone..�.�-� '..�.�....�......... <br /> ......................•. •....... <br /> Address _ 1'�Q :. City �c�4.�p.J _.......... ,� ��...7.. <br /> Z icense# .�` U... Phone <br /> Contractor's Name fq. t __. ..�6�1S.y..-x-+l�G...........:....L <br /> Apartment P <br /> Installation will serve: Residence ❑A House Commercial ❑Trailer Court 0 <br /> Mote! ❑Other .,�.1�bt-j.�....1.7'V• -- <br /> �y i <br /> Number of living units:.....'..... Number of bedrooms .... Garbage Grinder ....-....... Lot Size .....�D.. .. ....!4iw 5,........ <br /> Water Supply: Public System and name ..............: ...... .......................................... _--••••••.. ..............................Private <br /> Character of soil to a depth of 3 feet: Sonde] Silt❑ -Clay Q- . Peat❑ Sandy Loom.o -Clay Loam- -- = <br /> Hardpan ❑ Adobe:❑ Fill Material .............If Yes,type ..........................- CON <br /> Plot Ian, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse. alae.) <br /> { g <br /> p <br /> INSTALLATION: No septic tank or seepage pit permitted if public- sewer is available within 200 feet,} <br /> NEW i { p � <br /> h <br /> PACKAGE TREATMENT ] <br /> SEPTIC TANK Liquid Depth <br /> .........y.'.... ........elf........ •---- <br /> I % �Size_. .. . <br /> =w Co­pacity/. 1 0.-. /-Type Material.. Q _ ..:.. No. Compartments .............. ..... <br /> Distance to nearest: Well ......-,. Z?.�.................Foundation __1. ............ Prop. line ....$..... ....... <br /> • <br /> ..S- Total{ Length ...1 T_Q.. .......... <br /> LEACHING LINE Na, of Lines .r-. ........--•••--• <br /> '1:engl'h of-each_line.;�... _ _ � ....._ - ;9 <br /> 'D' Box _...tom_ Type Filter Material -AZO<.Y�- -M <br /> .----Depth filter .... /.lh-.--....................... <br /> a <br /> Distance to nearest: Well .... Foundation .............-' *... Property Line ........................en <br /> ' r <br /> SEEPAGE PIT Depth ...c�� ----- = -_ Rock Filled Yes No <br /> Diameter ........ Number ❑ <br /> Water Table Depth .---••-••...................................I........Rock Size 1__�----• <br /> FWell <br /> Distance to nearest: Weil 1 ..:..�` --......Foundation ...l.Q.__�"F. Prop. line ....-------•--......•_ <br /> --_.. <br /> REPAIR/ADDITION{Prev. Sanitation Permit# _ <br /> ............................ <br /> ••.. Date ...................... <br /> .) <br /> Septic Tank (Specify Requirements) - 1 ................, ... �.... <br /> Disposal Field (Specify Requirements) s -------------------------------------• ....................... ................. <br /> .. ...................................... ............... _..........•---.-----------.....-------------- ..........y................_........_............... <br /> r _ <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 Sart Joaquin Local Health District. Horne 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 '.......................................... <br /> (If oth t an owner{ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ............... ................ DATE ...... '. ................... <br /> BUILDING PERMIT ISSUED .....I........DATE ..............................•---•---•••.. <br /> ADDITIONAL COMMENTS --•--••--•........................•----............. ...................... <br /> P.... <br /> 4*_ ­ , "-,- <br /> .................................................. <br /> .....--................ .....- ... *. <br /> • Date .. -� :.. ..... <br /> _ .. <br /> Final In ... ... _ .:.... .... .:. . <br /> s SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/723M <br />