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FOR OFFICE USE: ' <br />/Q,,� APPLICATION FOR SANITATION PERMIT <br />----------------------------- - p� Triplicate) • � 7 (Complete in Tri licate {� Permit No..D-�� <br />7 Date Issued ; ._�ar_7a <br />-------_----------------------------------- ------------- jj This Permit Expirs 1 Year From Date Issued <br />Application is hereby made to the San Joaquin Local-Healt District for a permit to construct and install the work herein <br />described. This application is made in compliance `ith County Ordinance No -'5.49 and existing Rules and Regulations: <br />JOB ADDRESS/LOCATION <br />++]]pt % --— �- -_ �- %, F'.. - CENSUS TRACT ---------------•-•--•-•--- <br />. I �^{�_�_�_y__;t' <br />Owner's Name ._.--------------------------------------Phone-------- <br />Address------------- ---- ------------ ' -• ---_.. eF <br />City '2"'LJ_ <br />�p- / <br />Contractor s Name / ' t'� ? ' License # /hone - <br />Installation will serve .% Residence 0 ApartrAent H use,[z Commercial ❑Trailer Court ',❑ <br />M.oteli Other _ � = ------------- - <br />-- Number of bedrooms _`�--__Garba e Grinder _._ <br />Number of living units:-__ ._.-._ -'/0_ Lot Size --- _-- _--,/��c-_�f _ <br />Y l------------------•----------------------------•------------------------- ----- Private <br />Water Supply:Public System and name _ ______ <br />Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ } , Peat ❑ Sandy Loam Clay Loam ❑ <br />Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ____________________________ <br />(Plot plan, showing size of lot, location of system in reiat'��on toJwell, ypi <br />s ,ld gs tc. must be placed on reverse side.) <br />NEW INSTALLATION: (No septic tank or seepage pit permittpd�if public sewer is available within 200 feet,) j <br />PACKAGE TREATMENT f ] SEPTIC TANK,____ .---------------- Liquid Depth __��,----------- <br />Capacity _ _.2.0 Type _Ae_" S ltvlaterial_- ,_G_Y o. Compartments 2_1 — _ C_5�1 <br />Distance .to nearest: Well _�4Q__�_____________Foundation ..-/ -_- Prop. Line -------- _.�__.______ <br />i i <br />LEACHING LINE No. of Lines -4y ---------------- <br />Length of each <br />jj line___ ------_______.__.___ Tota! Length ___..._._.__� <br />D' Box4-_._�ype Filter Material Fr%/60�bepth Filter Material � �_ <br />/_ -1 <br />Distance to nearest; Wel _._:_-_ ------ Foundation _13 ----------------- --------- Property Line --- F0_ I <br />PIT [ J Depth ___________________ Diameter ------ *------- Number --------- _------------------ Rock Filled Yes ❑ No C3 (_1`4 <br />Water Table Depth --------------------------------------- -------- Rock Size -------------------------------- <br />I <br />Distance t nearest: Well. _: P4__-.*________---�--- <br />------------Foundation -------------------- Prop. Line ---------------------- 0' <br />REPAIR/ADDITION(Prev. Sanitation Permif#`_�~--'------------------- ---- Date ---------------------------------- <br />SepticTank (Specify Requirements) --------------------------------------`------------------------------------------------------------------- ..------------------------_- <br />Disposal Field (Specify Requirements) _________________ <br />-------------------------------------------- — -------------------------------------------------------------------- -I----------------------- <br />--------------------------------------------------------------------------------I ----------------------------------------------------------------------------------- ------------------------------------- <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: I * � <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 IS. <br />as to become subject to Workman's Compensation laws of California t <br />Signed ------- Owner <br />By---------- -- -------------- Titfe --------- -- <br />(If o an owner) <br />h . , FOR QEPARTMENT USE. ONLY <br />APPLICATION ACCEPTED BY.Go�TT = DATE . r <br />BUILDING PERMIT ISSUED- - __ _ - ATE <br />L COMMENTS o' !•-GG:e ---- r?---------�� <br />ADDITIONIAL . <br />.{eh61.P_ <br />4.!4Ll24Q------------ 74 ---------- --------------------- ----- <br />Final Inspection by:._ _-------- Date __ . -__- � 1 - <br />-- - f - ---- - --- =- <br />f------------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT," i <br />.o- <br />� E. H. 9 1-'d8 Rev. SM <br />