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FOR OFFICE USE: <br /> • ................... APPLICATION'VOR SANITATION PERMIT <br />................ Permit No. .7��. <br /> (Complete in Triplicate) <br /> . This Permit Expires t Year From Date Issued Date Issued <br /> Application is hereby made to the Stan Joaquin Local Health District for a permit to construct and install the work herein <br /> described, This application is madelin compliance with County Ordinance No. 549 and existing Rules and Regulations- <br /> JOBAD©KESS/LOCATION .--•- - "� l- ci..' !?�OJ ................. ..................CENSUS TRACT ................---....... <br /> Owner's Name .d7 ...-�.t��e"-_%.--•..................................................:�._......:..............-.Phone <br /> � r7 <br /> Address .....� �dii- ..--....... -• ------------­-......................City . .....1� !1��'�._...........-.._.._......:.. j <br /> Contractor's Name ..,1 .-1 5 :`oZ.- e!!r lC-t------ -------------------License $` 1��'.... Phone slY2 1F.W.0 <br /> Installation will serve: Residence Q Apartment House`0 Commercial raller�t ❑ <br /> Motel Q Other /0 x 4'D <br /> _Dumber of living units:....... ---- Number of bedrooms ../.....Garbage Grinder 11—c:2. Lot.Size ....... 0•' ........... <br /> -Water Supply: Public System and name .................................................... ............................... ...I --•-----..........Private,' <br /> Character of soil to a depth of 3 feet. Sand Silt❑ Clay ❑ Peat❑ Sandy Looin,o Clay Loom <br /> Hardpan ❑ Adobe❑ Fill Material .... .......if yes,tyP9.....:......... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available:.-"'within.200 feet,) <br /> • L � ........................... <br /> } <br /> PACKAGE TREATMENT I ] SEPTICTANKI ] Size_--� .�-••----•-------•--.... iquid Depth <br /> I <br /> Capacity TYPe . Material u.7` No. Compartments <br /> .... . <br /> Distance.to nearest. Well es . .. .Foundation ..lel . Prop. Line __ AO...1=-. <br /> LEACHING LINE ] No. of Lines ....`----------•--.---- Length of each line........' .`....-.- Total Length .:..!lei.../........C7 <br /> D' Box ...�.._- Type Filter Material �. � <br /> .....Depth Filter Material .� .......... <br /> Distance to nearest: Well _.... .._.::._._ Foundation Property Line .3fCI,a...........N <br /> SEEPAGE PIT [ I Depth -------------------- Diameter ............ Number ..............................Rock' Filled Yes ❑ No 0 4 <br /> Water Table Depth - .Rock Size::-' _____ <br /> i - <br /> Distance to nearest; Well ........................................Foundation ::`_'--------...... Prop. Line ------------_-------- <br /> ------------------------- <br /> Septic <br /> -------- ---------- -y <br /> REPAIR/ADDITION(Prey. Sanitation Permit# -----..........------------•................ Date --------_- S <br /> r • <br /> Septic Tank (Specify Requirements) ......................................... .....................--•-................•-•.................................... <br /> . , <br /> Disposal Field (Specify Requirements) ......................................... -•----------------...----------------------------------------.. ---_---------_-- <br /> --------------------I...... <br /> -- ..--....--------------------•--•--. ----•------------------------ •----------------------------•--••--------------•--•------- ........:-............ .--... .............................................. . <br /> ------------------ ------------------------------------- ------------------w. --•.............................. ......................................................... <br /> [{Draw existing and required addition on reverse side) • <br /> I hereby certify that I have prepare)d 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 /> "I certify that in the performance of the work Ear"which this permit is Issued, i shall not employ any person in such manner <br /> as to become subject to Workrnan's Compensation laws of California." <br /> Signed _ -----------------------------------------------••........-------- -•--------------------- Owner <br /> BY .-s-- - ----------------------------•-••-•-•--•----- Title .......- <br /> I{ (if other than owner) <br /> 62 l FOR DEPARTMENT USE ONLY i <br /> f <br /> APPLICATION ACCEPTED BY ' h'� .. . _ <br /> DAY --------------=-- ---- <br /> f <br /> BUILDING PERMIT ISSUED DATE -.:... <br /> E <br /> ADDITIONAL COMMENTS _ Zr c„l� Z��.-�f�------ Ar�.� llr°.2_. . .�1C1�- �> <br /> - - �� % -..----•--_--------------- <br /> ' .... . . ......... <br /> ........ ................. ............... <br /> . - ------------ -- <br /> Final Inspection by. .. <br /> -�• Dale . . .. -. <br /> ,f / <br /> EH 13 24 1-55 v. 5M SAN JOAQUIN LOCAL HEALTH-„DISTRICT 8/7 4 3M <br />