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FOR OFFICE USE: APPLICATIO OR SANITATION,PRRMITTM <br /> S <br /> QCompfete in Tri hp ,eatelPermit No. -- 7 T <br /> --.-...--.� -.---.- <br /> ------------------------------- - <br /> ----------------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health.District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> r <br /> JOBADDRESS/LOCATIO/N` TRACT __-_--------------------- <br /> Owner's Name �'�`C Pt -------- -•----------------•---------------------------------- -------------------Phonee�4c 'i— c� <br /> Address r �--------17-----A�.'.0 C� CitY f����4----- -------•------------------•-------------------•---- <br /> Contractor's Name ------ + -,-- t' -----------------------------------------License iP(( Q-------- ---- Phone �6--------- -- <br /> Installation will serve: Residence ® Apartment House❑ Commercial ❑Trailer Court ile., <br /> ',EMotel F] Other -------------------------------------------- <br /> Number of living units:-.-/------- Number of bedrooms 3---_-_-Garbage Grinder ------------ Lot ,�------------------------------- <br /> ------ <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private r%;, <br /> Character of soil to a depth of 3 feet: Sand's Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, locationrof 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 /> PACKAGE TREATMENT { ] SEPTIC TANK'[ ] .` Size------ _ q p N/ <br /> v <br /> Capacity/7"0Q------- Type(P-IX_Cc _��­Materiai 64-_q(?44C_70�PNo. Compartments <br /> Distance to nearest: Well ---_�.-----_---------------Foundation -120-------------- Prop. Line _____--__-_-.--_--� <br /> LEACHING LINE [ j No. of Lines _.Z---------------- Length of each line-___S- -' ---- Total Length ..._.._.-- <br /> D' Box .. _.____ Type Filter Material <br /> � �z' // <br /> _______ _______________________ <br /> Depth Filter Material __ _ _____ _ ;� <br /> Distance to nearest: Well ----15DO----------- Foundation -----I-P-__--__-___ Property Line <br /> ------------------•----- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line -----•-•--.-.------._� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Dote ______________.___________________] <br /> Septic Tank (Specify Requirements) _ X-10 ---�l-I,1-e-----6-,- '` --------------------------------------------------------- <br /> Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------•----------- <br /> -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- <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 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 for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workma s Compensation of California." <br /> Signed - ------ ---- = ----- Owner <br /> BY --- 4 -f-------------- Title -- <br /> (If other than owner] <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- --- --- ------------------------------------------------------------- DATE r,�`?----- ------------------ <br /> BUILDING PERMIT ISSUED _ _ --------- - DATE -------- ------- <br /> ADDITIONAL COMMENTS __ syr y-----�-----',`�--- '"r '� � < ""`{ /t- ��'' ----------------------•-•-- <br /> ---------------- -- ----- <br /> --- ------------------------------------ <br /> --------------------------- ---------------------------------------------- ------- -- ---- <br /> Final Inspection by: ----------------------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b$ Rev. 5M <br />