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rvR VrFT%.,C vac <br /> .............• ---._.._.. .... .............. <br /> APPLICATION FOR SANITATION PSRMfr-- , <br /> ---•.. � - Permit No.�.�..:. .�1..� <br /> (Complete in Triplicate) <br /> .... ................................••--•-•---........ Dab ):sued <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 constwct and Install the work herein <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 108 ADDRESS/LOCATION .... / ..`., r...... Q. G1.. .�1�is 1...........................CENSUS TRACT ...--..................... <br /> Owner's Name .....--••-- /• ...` °.�►c.c.. ............................................................Phone .................................... <br /> Address .... .............................Cl ............................. ....................... <br /> Contractor's Name ...... .... ..........................license+ :��; - ..... Phone :Z��d .... <br /> installation will serve: Residence partment House C] Commercial QTrollw Court r] <br /> Motel []Other <br /> Number of living units:......../ Number of bedrooms ......Garbage Grinder .... Lot Size ........................ <br /> Water Supply: Public System and name ............. ..........................................---. .....................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ID Silt❑ Clay 0 Peat 0' Sandy Loam (7 day loam Q" <br /> Hardpan❑ Adobe Ul-f'ilrMaterial .,�t1. .If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells,-buildings, etc. must be placed an-reverse side.) <br /> NEW INSTALLATION: IN* septic tank or seepage pit permitted if public sewer is available within 200 feet,) X <br /> � l <br /> PACKAGE TREATMENT [ ] SEPTIC TANK;ff Si e �................... liquid Depth .._ _„f.�. ....... <br /> Capacity.. .'...�...... Type Material €: No. Compartments ...... -— <br /> Distance to nearest: Well . .,ef�y, ,� ..............Foundation ...... Prop. line-,rZ- ............r <br /> _EACHING LINE U--'-N—o. of Lines <br /> ......��::..._.. length of each Iirte....� Total length,1...ZA...J......,...� <br /> 'D' Box .. Type Filter Material Depth Filter Material .� <br /> • '•.- <br /> Distances: o nearest, Well .. ..... Foundation .. ..u.K.......... Property Line,<-. <br /> SEEPAGE PIT Depth ....... Diameter Number . ... .... Rock Filled Yes ••.. o• 3 <br /> .�..� p c -..S •j• <br /> Water Tobie Depth .. ...Rock$ize <br /> Distance to nearest: Well •-----/V/-,�`......................Foundation .../.O.f........ Prop. Line ............. N <br /> REPAIR/ADDITION[Prov. Sanitation Permit# ............................................ Date .................................. <br /> ) D <br /> SepticTank ISpecify Requirements) ..........--•-•.......................... ...................................«....................................................... <br /> DEsoosalField ISpecify Requirements) --•................•...._...._., .....-•---••---••••--•-..........................................-................................:. <br /> ....-•----....--•-•--•--•...........................•---•--..............................------..........................,........................................---................. <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 dere In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or I1cen- <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 /> -i:aned ....--•--•... ..... •..................... Owner <br /> . Title �- '� <br /> .•---•-•-••-•--..... <br /> By <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ............... ._.... DATE ./.Q-2voa-2 a............_.......:-: <br /> ....... .... <br /> BUILDING PERMIT ISSUED .......... ..:....:. ... ........ ..... ............... .. _... .. .......................DATE-................................... <br /> ..._... <br /> ADDITIONALCOMMENTS/.. 4l�C_.._.. . ...................................................................-...........--•---•-•-•-•........._.._.I........... <br /> 1. �7 . .....-- <br /> ...---- <br /> :. <br /> Final Inspection b DateEH <br /> 13 2}r 1-6ti ,may. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />