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. _ �FG'R OFFECf USE: ���� <br /> APPAIC;ATIONFv n_SANITATION PERMIT----------------------------------- <br /> R <br /> { (Complete in;Triplicate) <br /> Permit No: <br /> - - -- w <br /> ;� Date Issued _- __�� <br /> _______________ ----._."_____.___-_____. This Permit Expires 1 Year From Date Issued <br /> r <br /> 'Application is hereby made to the San Joaquin Local Health District for a permit tomconstructand'•�install-the_work herein <br /> described. This application is made in co pl'aoe bUcith County Ordinance No. 549 and existing•Rules and``Regulations: <br /> JOB ADDRESSjLOCATI ______ <br /> ----- -- --HRBEFI--------�`V- ---------- CENSUS TRACT,,.'-_ <br /> Owner's Name -------- b -UrH--------=- Phone. I- _7L� <br /> �1 <br /> ,M <br /> Addres's - =- .L�-1- _M. - 0Cityl__ `_-`�-p�l� y ---' ------ 3 <br /> Contractor's Name _-Q_W.V E-K---------------- -------------•----- -.-------.License # ----- �_-4hone ;4733'1:1 0 <br /> Installation will serve: Residence elpartment House❑ Commercial ❑Trailer Court <br /> Motel ❑Other ----------------------- ------------ �J <br /> Nurimber of living units:----.----- Number of bedrooms ____Garbage Grinder !1�_O___ Lot Size IAcKE196M"_......... <br /> . <br /> &t7_.� <br /> -- ---- <br /> Water Supply: Public System and name ----------------- --------------------------------------- <br /> -- _-- -=__=-Private 1 <br /> Character-of soi'l to a.deptb.of.3-feet: Sand' —Siit-El� Clay .❑_-Peat. _. . ._Sandy-Loam. ❑,- .Clay Loam-❑— <br /> HardpanlC --Adobe-[ —FillMateria6A-i r<-1f;;Vw_;t- - - - ____________________ <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 seepa pit permitted if public sewer is available within 200 feet,) / 4 <br /> t � . <br /> PACKAGE TREATMENT { ] SEPTIC TANK , i Size____1_0_X----6------_---_ Liquid Depth -_s----- -------- 0 <br /> . . .. <br /> _ M <br /> Capacity-- -_�3. =-rT~yp !- Material_ QN `No. Compartments - -------- 4 <br /> 1 <br /> D' tante to nearest:"1WN tl __�__- 1 __."+`...--__--_Foundation ___1A0__________: Prop. Line ___ ______ <br /> � . <br /> 01 <br /> LEACHING LINE No. of Lyiinres -----/-------------- Length of each line____f0L9____ .____ Total Length ___�Ql -------------- <br /> r�! Typ iQ C> _.Depth Filter iMaterial -----I�--'�--------------t----------- t <br /> D' Box __ <br /> e Fi ter Mafieyr} 7 ,4_.. ; <br /> istance to n'e�rest: Well --�� ---------- Foundation ---- -"� Property Line ---,5__________ ______ <br /> t X/® ___ Rock Filled Yes l <br /> SEEPAGE PIT- [ Depth _- .-__.--__-.Diamete�A-----_•------- Number -------- ---------,- ` ❑ i <br /> tr <br /> Water Table Depth __/Q___________________ Rock Size �_ _'"_ ___. :_ I <br /> r Distance to nearest: Well _._r' ______________________Foundation Prop. Line ____ _ P <br /> REPAIR/ADDITION(Prey:Sanitation Permit# ------ ----- --`----'------------------ Date ------------_----..---_-- ) } <br /> Septic Tank (Specify Jtequirements) ____---_-- _______.___ <br /> s. ,11 <br /> Disposal Field (Specify Requirements) - ---------------------------------- -------- ----- - 4 <br /> --- ----- --- ---- --- -- -- ------------------------ <br /> -------------- <br /> - <br /> -- - - --- --- <br /> ------ ---- - <br /> -- ----------- ---- - ----------- ------ -- _---- -------------------------------------------- <br /> (Draw <br /> - -------- - ---- - - <br /> (Draw existing and required addition on reverse side) 1� ; <br /> I hereby certify that I have prepared this application and that the work will be done inaccordance with San Joaquin <br /> County Ordinances,' State Laws, and Rules and%Regulations of the San Joaquin Local Health District. Home owner or licen i <br /> sed agents signature certifies the following: 5 <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, t <br /> as to ome sulijw to Workman's Compensation laws of California." '€ <br /> g -------- ------- ------------- - ------------------------------ Owner , <br /> BX: ------ -a -- --- Ei = ---._. Title --- -- ------------------------------------------------------------ <br /> • _ <br /> (lf other than, owner) ' <br /> FOR DEPARTMENT USE ONLY ! ) <br /> APPLICATI& ACCEPTED BY A----Ti®T_iR_U---------------------------------------------- ---------------------------- <br /> k" DATE ------ <br /> INMlD DATE <br /> - <br /> 4ADD TNAL °MVE TSp`r4 ✓ <br /> I w7 <br /> _. <br /> /- <br /> ------- <br /> . Se <br /> IM <br /> n+i: - ---------------- ------ ------ <br /> - I Msri - '�S <br /> Fina Inspection by. ---- ---- �T�T - , ------------_ --- ------ <br /> NN i <br /> JO)SQUIN ,LOCAL HEALTH-�DISTRIC� (.`\ <br /> E. H.9 1•'68 Rev. 5M <br />