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�. tVl• OFFICE USE: <br /> APPLICATION FOR SANITATION PERMITs IComplete.in Triplicate) Permit No, ._-A.:'.- <br /> ��--..a....'.........'..=•...... This Permit Expires ? Year From bat*Issued Date Issued .. <br /> GS- L <br /> Appfictit€on is hereby �" q <br /> made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is fn*a in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCMIOW'.."_'.,q. ._ .__ i <br /> _r.................. <br /> ... CEN5US <br /> Owner .TRACT's Name .. ,:�_.� - - cL(,t�.,..... L ---...-... ......... ................ <br /> Address �d`�- �? �l.�_ ..........................-. t. - <br /> • - ••-•- one <br /> City .. ....__...-:r ..................C <br /> Contractor's Name ��`-�.:1.�_. 1�1��?r�` ; .... .................. . <br /> `.5 .. � Mone ! T. • SPS± . <br /> Instal lation will serve: Residence 10 Apartment House fl Commercial kTraller Court - <br /> Motel (]Other ...-. _ <br /> ..._ <br /> Number of living units:_---- ... Number of bedrooms Garboge Gr€nder <br /> Lot Size <br /> Water supply. Public System and name <br /> .... ..- <br /> Character f s •••••••••••--•••-••--••Private [] <br /> 0 oil to a depth of 3 feet: Sand.] Sift 0 Clay 0 ' Peat[� Sandy Loom C❑ Clay Loam Q <br /> I� Hardpan p n Q Adobe fl Fill Materia! If yes,type <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse slde.)'' <br /> NEW INSTALLATION: Wo septic�Rtank or seepage pit,permitted If public sewer is available within 200 feet,( <br /> PACKAGE TREATMENT ( ] -SEPTIC TANK f ] <br /> n Size.... <br /> ................................................ <br /> iqul •Depth <br /> p Type <br /> A/- r- ,7.''- Material.eVt0 _ No. Compartments <br /> Of <br /> Distance to nearest: Well ------ <br /> I <br /> � ......................Foundation ff a Prop. Line �_........._. <br /> LEACHING LINE [ ] No. of Lines .- <br /> " <br /> �' ----- ----- length of each line__. ... ......... Total Length rf.��..........._--• <br /> ©' Box .. - Type.-Filter Material ...... •_. ----.Depth Filter Material ............... ... . <br /> [ l De a nearest: Well ...../--. ---•---- Foundation <br /> Distance to, O f . --.o!l�d• Property Line -.-fV�..�_.._...._. <br /> SEEPAGE PIT / � <br /> x ., '.. Diameter � ., �"- Number ..--. <br /> • ��-- ------... ..,... Rock Filled• YeaNo C] <br /> Water Table Depth ------------------------------------------------Rock Size <br /> -----•----- <br /> I. � <br /> Distance to Barest: Well���-•-•.....-----•... .....Foundation .-. D__--•-•- Prop. Line ./ ...... <br /> ....--- <br /> / Permit�# ...... --------•...................... Date ------••--•=--• -- <br /> t. <br /> .Septic Tank S ctrl Requirements)..__.- <br /> ADDITION(Prev.IPrev. Sanitation <br /> I <br /> ,Disposal Field (Specify Requirementsl ____________ _ <br /> -------•........................................... <br /> jr <br /> la ---:----•--. ----,--•--•-•-•----•------------••---••----•---• -••---•----------•....................:.:............. <br /> -------­------------ ------• --------•---------- - =_.. ••-=•--- <br /> (Draw existing and required addition on reverse side) <br /> I :hereby certify that I have prepareld 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 San Joaquin Local Health,District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> y "I certify that in the performance of�4he work for'which this permit is issued I shall not em !o an <br /> as to become subject to Workman's Compensation laws of California." P y Y person in such manner <br /> Signed -.-.. �E <br /> ------------•---- Owner <br /> BY ' -- <br /> .._..._ Title <br /> (If other than owner) ilfM - -------------- ...-------•--------.-....- <br /> FOR RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _----._ <br /> BUILDING PERMIT ISSUED ----. --- --.••'I�- - - DATE ... -- <br /> ADDITIONAL COMMENTS --•-----...-- DATE -----=.... ... <br /> --------•---•--------• .............. ......... ....-•-- ...._. <br /> Final Inspection b ' <br /> - <br /> .............Date <br /> Eli 13 2h1-6f3 Rev. 5M i <br /> i SAN JOAQUIN :LOCAL HEALTH DISTRICT /A 3M <br /> ,, <br />