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FOR OFFICE USE. APPLICATION FOR SANITATION Pt:1tMtT <br /> ...................................................... . % o 7 <br /> Permit No. 7S <br /> (Complete in Triplicate) ,.................. <br /> ---------••.........................•-•-----••-----•----- ,,rDate issued �`'Z S-- 7 S� <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healthbi strict for a permit to construct and install the work herein <br /> described. This application is made in compliance with Co6nty Ordinance No. 5.49 and existing Rules and Regulations: <br /> JOB-ADDRESS LOCATION .. --l. .. ,.___..•.....................................................CENSUS TRACT . <br /> Owner's Name ..............2��_ .?................. --.... .................................. ........:. Phone . _;7........_...... ....---•- <br /> Address --.---..-___--------f Q 3..._.. _�"�� Pte.. ........_---_'"`cy ---------------- =---•=-•- <br /> it4-•-•------•-----•-:_.............-......_.... . <br /> Q 4 <br /> Contractors Name ---------- -- ._. --.license #,:2i6`f,7Y3....... Phone <br /> installation will serve: ResidenceApartment House fl Commercial❑Traller Court J <br /> Motel ❑Other ...------_ ___......,_''��*__ <br /> Number of living units:....!.---_._ Number of bedrooms ...;......Garbage Grinder ............ Lot Size_. <br /> Water Supply: PublicSystem-and name-................. .............. ...�... Private' <br /> .......... - - ..... --_..... .... <br /> Character oflsoll to a depth of 3 feet: Sand>L] Silt❑ Clay ❑ Peat❑,4 Sandy Loam ❑f Clay Loam <br /> Hardpan❑ Adobe❑ Fill Material .. ........ If yes,type................ ............ <br /> (Plot'pion,-showing-'size•of.lot, location of system in reliition to welis,•buildings, etc. must be placed. on reverse side.) <br /> �-� 1- % <br /> NEW INSTALLATION:, (No septic tank'or-seepage pit permitted--if-publie'sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK I ] ................. . Liquid Depth <br /> Capacity <br /> a act . <br /> Type -._.�Mater€al-•- ••-`•----•- No. Com artments�.................:.... <br /> tY - s YP I P� 6 <br /> 5 <br /> Di't e'to nearest: Well ............... ...................Foundation -..._.....__.._.._.... Prop..Line ...................... <br /> � <br /> s 4 t , i <br /> LEACHING LINE""[] No. of Lines I.............. ....... Length of each fine. "..s�q...__.....__ Total Length <br /> ;�. t •---•-••- <br /> ©' Ilox Type Filter Material 9 ...Depth°Filter'Material -}" <br /> _..--• Yp <br /> Distance to nearest: Well ............ Foundation ....................... Property Line ...._....................V <br /> SEEPAGE PIT ( ] Depth Diameter E:. .` Number, .............i-.__-........ Rock Filled Yes ❑ No 0V <br /> Water Table Depth ____.__°"".""..__...Rock Size . ............................. <br /> Distance to nearest. Well ------- - ---=.._•,_,'.Foundation .!.................. Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date <br /> -- s <br /> Septic Tank {Specify Requirements) -------------- -•-•---- ................4- <br /> ..�_�:••......................... - ............................ <br /> t <br /> Disposal Fieldj(Specify Requirements) ._._.. �,�1 .--------_*...�_. ....-• � !�•--•-•-------•----_----•-•--- •--------------•----- <br /> -•--•--_ � <br /> ... ------••-- - . f�� <br /> I f <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 Son Joaquin <br /> County Ordinances,-State•Laws,and,Rules-and-Regulations•of the'Saii-lataquin'Local•Health:District: Maine 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 shalt not employ any person in such manner <br /> as to become subject to Workman's Compensation~laws af4Californla." <br /> Signed ---------------------• --- _- ........ Owner <br /> BY -------- . <br /> `'W__." _....--- Title _...-- ..................... ----------------•---- <br /> (if er than owner) <br /> R PART USE ONLY <br /> APPLICATION ACCEPTED BY . ---... -- - ----- - ---- --- ---- - _-...-DATE ....Z-ZS= 7 ------------- <br /> .BUILDING PERMIT ISSUED -..-------------_...................................................... <br /> ............. ......------......_DATE ... --................-----•--------.. <br /> ADDITIONALCOMMENTS ---------------------------------------.......-_..-_------------------------------------------------------- •---..... ...................................... <br /> - -----•----•- ....... • ---•------ <br /> -•-•-------------- -----------_-- - -- -•• --- -- ..... <br /> Final Inspection by: .... _Date ....2c.. k-..7- ---------------- <br /> EH 13 2h 1.-68 Rev. 5m SAN JOAQUIN LO AL HEALTH DISTRICT 8 711 3M <br />