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r -.+14_n.,sC <br /> FOR OFFICE USE: gpPLICAMON 1FOR SANITATION PERMIT <br /> Icon in Triplicate) Permit No. ...7. ......3Y <br /> .................................._._.........._.... This Permit Expires 1 Year From Date Issued <br /> Dote Issued .5............... <br /> r <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 /> J08 ADDRESS/l0 TION ff ._...��lPcn� CENSUS TRACT , c <br /> n ---•- ...... ......... .......................... <br /> Owner's Name ... •.............•--•-----:-.......:....... Phone.. .............. : <br /> . ..:.... . .. <br /> Address .... Z nf�....... ...... _1..P ? .. ..._. city ..... . . ...�..................:........._.....�................ <br /> Contractor's Name ..License # ... Phone I <br /> .....1 :�............... ........... <br /> Installation will serve: _Residence Apartment House[] Commercial ;]Trailer Court 0 f <br /> -D Motel ❑Other ............... <br /> Number of living units:.... ....... 'Number of bedrooms �arboge Grinder ............ Lot Size .... ...... <br /> Water Supply: Public System and name ' f; :. ------­----.... Private ❑ <br /> i <br /> Character of soil to a depth-of 3 feet: Sand Q. -.Silt❑ ..Clay ❑ 'Pea't-0 Sandy Loamf Ciay-loamm 1 �O <br /> t Hardpan ❑ Adobe Q Fill M6teriol ............ If yes,type ............................ 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 seepage pit permitted-if,public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC NK{ ] Size...............I........................... ... Liquid Depth ........_. ............... <br /> Capacity ....... .... Type .................. Material...................... o. Compartments ...:.:...........:.... l <br /> Distance to nearest: Well .�. .....................Foundation .. Prop. Line f <br /> LEACHING LINE [ ] No. of lines'. ... Length of each line..:............. ... Total Length ._........ ;....... <br /> . .... . .... .. .. ..... <br /> s <br /> 'D' Box ............ Type Filter Material�..............Depth Filter M terial .................................x:- ....... <br /> Distance to nearest: Well .. .. ......... Foundation .... Property Line <br /> SEEPAGE PIT [,) Depth Q; <br /> ......_I._.....---- Diame, r ........_...I... Number .•.................... ...... Rock Filled Yes No <br /> Water Table Depth .. ............................mak size...... ���- --...... <br /> Distance`to.-nares Well`-� _ .......................:..Foundot#on _-- ............. Prop. line ...... .............. <br /> REPAIR/ADDITION(Prev.,.Sanitotion,Permit# :........:- _.... Date ............... ----------- <br /> Septic Tank (Specify Requirements) ...................... ................ .......... .:._:z._._..:.. ._-; ----- ......................... --- -----Disposal Field (Speci Requirements) . t: " _5'1­_.__.1...... <br /> ---:-`:---___ <br /> .. _._�._._ - r.. _ --may .....:�...-••. ..�- -. .....� ........-._ <br /> (Draw existing and required-addition on reverse side) # <br /> I hereby certify that i have prepared this application and`th_at the work will be;done,,in_accordonce with Sari Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of:the San Joaquin local Health District. Home owner_ or licen. <br /> sed agents ature certifies t ollowing: i <br /> "I certify :n the performa c f the work for which this permit is issued, I shall not employ any person in such manner <br /> as to beco subject to Work 's the <br /> laws of:Collfornia." <br /> Si ned -- Owner <br /> Signed .: _. ..: ..._ <br /> BYC...L._:. ..................................... <br /> (If other than owner) 1i E <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y ........ ..i. . CL,...:... ...... .. DATE'.... ...=,�. ...'.............. <br /> BUiIDING PERMIT ISSUED .....:.' L.:� _.:: :: r ', _. ... �.r1 .:........._. �.....DATE . ........ ................ <br /> .................:..........................:.... .. :..:.. ,.. <br /> ADDITIONAL COMMENTS ...:... " • w <br /> .................•-----•--------- .. .................._...................'�-:........... <br /> ... .- .»......., ,.,r. .. ...��.,r..,._ ._ ,. ..,....._ <br /> ...........................••-•--•• -•-•-.... ....---••- ---------• ... .. ----....--•-• ............ •-----•-•- -•- ---•--------•----•----. ------------•-- <br /> r r <br /> -- ---- -- --- - --- ---- --- - <br /> Final Inspection --•• .._.:... ... .. ....... ....................... Date .:..... ....... ... <br /> SAN JOAQUIN tbCAL HEALTH DISTRICT <br /> E. H.13 24 W68 Rev. 5M 7/72 3-M <br />