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y FOR OFFICE USE: <br /> LICATION FOR SANITATION PERMC <br /> Permit No 1 -- <br /> ----------------------------------------- ------------- <br /> ----3-----6-�-.. <br /> - (CompfEs"lo in Triplicate) ' <br /> ---------- --------------------------------------------- <br /> Date Issued -_----'_.------.--. <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 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 /> Q <br /> JOB ADDRESS/LOCATIO --_ �------------------CENSUS TRACT <br /> N --------- _{--�`-=--[--- ----.----- -- ,- - <br /> jf <br /> --------------------------Phone .ll~bz 1 ---------- ' <br /> Owner's Name --------:._lI( Ll'Gr'`- GJq.- L ---i'C� <br /> Address City <br /> -- <br /> Contractor's Name ------------ ----=- r. Liicense # -� .--��----- Phone - --- -- ---- - -- -• ------ i <br /> i,.. <br /> Installation will serve: Re.si"dente ❑ Apartment H�ous�e''0 Commercial :❑Trailer Court ;❑ <br /> Motel F] Other_AgAk 6 <br /> Number of living units------------- Number of bedrooms ------f-_Garbage"Grinder ------------ Lot Size ------- <br /> Water Supply: Public System and name ------------------------ ---.---------------- -- Private ❑ <br /> Character of'soil'to a depth of 3 feet: Sand' Silt �`Cla Peat Sand Loam Clay Loam <br /> P ❑ ❑ y I] ,❑ y ❑ Y ❑ <br /> ,.; Hardpan ❑ Adobe Fill%Material ------------ If yes, type ----------------- ----- p� " <br /> h' . <br /> iplot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] <br /> � <br /> NEW INSTALLATION: iNo septic tank or,seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ],e "SEPTIC TANK f 'I Size---------------------------------------- Liquid Depth <br /> Ca acct Type - ---- Material---------------------- No. Compartments ------- ------- <br /> p Y --------- ------- Yfi� ; <br /> Distance-to nearest: Well' ;---------------------------------Foundation----------------------- Prop. Line --_------------------ <br /> LEACHING LINE [ ] No. of Lines -----------------:` ---- -Length of each line---------------------------- Total Length ------.----.---_----------- <br /> 'D' Box ------------ Type Filter'Material --------------------Depth Filter Material ---------_-._--_-.--.---------------.------- <br /> Distance`to nearest: Well ------------------------ Foundation ------------------------ Property Line --.--------------•------ <br /> SEEPAGE PIT [ ] Depth" ------------- ------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ❑ �n <br /> WaterTable Depth ------------------------------------------------Rock Size ----------------------- -------- <br /> nearest..nearest: Well ------------------------- -------------Foundation -------------- --- Prop. Line -�,_= .--w-=--- �---� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _-.r---------------------'-___--____ ----- Date --_-_--- ) <br /> a J.-,- <br /> Septic Tank (Specify Requirements) ------------------ -------------------------- <br /> --------- ----------- = � - <br /> - - <br /> Disposal Field (Specify Requirements) ----------a..-----...f rX ��' ft'r r? „ r <br /> I -------------------------------------- ---------------------------- ' <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. Homeowner 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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed C---- OwnerBY -- -------- ---`"-- ------- <br /> Title - o `�------------------------------------------- <br /> (If of er t owner) <br /> �F7OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTS BY / -------- DATE �`l 7. <br /> BUILDING PERMIT ISSUED ------------------------- DATE <br /> ------------------ <br /> ADDITIONAL COMMENTS --_--------------------- ------------ ------------------=--------------------------- <br /> - <br /> ----------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- ---- --------------------------------- ---------------------------------------------------- ------------------------------------- <br /> --------------------------------------- ---- ----- - <br /> - - - -- -- -- --- -- - <br /> Final Inspection b --------------Date _.. - -. -- r -- . <br /> N JOAQU LOCAL HEALTH DISTRICT <br /> C W 0 1-'AA Paw RAA <br />