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T <br /> FOR OFFICE USE: <br /> i IComplet .SAIVTATION PERMIT <br /> APPLICATION FOR <br /> - Permit No. __.7:�S7 <br /> 1. a in Triplicate) <br /> ------------------- --------------------------- <br /> ----- -----------------------------------------_---------- This Permit Expires+)-,€Year From Date Issued Date Issued <br /> 'I <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 /> JOB ADDRESS/LOCATION ---------- _7_.----11-e-- �__�---- ---c'a`r - ------ °---a"`-'_CENSUS TRACT ------------------------- <br /> - <br /> Owner's Name - '------------- --- � --,---�- ----------------------- Phone '��-------------------------- <br /> ----------------------- <br /> Z447 <br /> 4�___----�.�.... <br /> Address -------- �� - _""''"' '................. City <br /> ----------------------- <br /> Contractor's Name _: ----'2-O f <br /> _ - -------------------------- -----.License #o4'7Y/_'; _7--- Phone <br /> Installation will server +ResidenceApartment House❑ Commercial : TrailCourt ;❑ <br /> 4 # <br /> ' Motel [] Other ------------------------------ ----------- <br /> Number of living units:----- .__ Number ofbedroomss--a____•Garbage Grinder/O'��--___ Lot Size _�� _�_�_�� -_____._ <br /> Water Supply: Public System and name ------ -----------------------'-----------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ c f Adobe-1k Fill Material ------------ If yes,type ____________________________ <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 TANK _ _ Liquid Depth ___Z;------------------- <br /> I Capacityl.7ov-4,124 Type -G Material___ -_ ` .No, Compartments __ -........:.... <br /> Distance to nearest: Well " ' _______Foundation __.z f_______ Prop. Line ------ `7______ <br /> LEACHING LINE No, of Lines _____ ________ ' d <br /> __________ Length of each line_____�t�_____-___�_ Total Length ._�Q_________________ <br /> 'D' Box -_.l----- Type Filter Material AODepth Filter Material ___A?__ ____________________________ <br /> Distance to nearest: Well?fl' r.� Foundation ---r�0'-------------- Property Line ---- r__. <br /> ( SEEPAGE PIT Depth __c _rDiameter Number -----/------------------ Rock Filled Yes No i❑ <br /> Water Table Depth Cj ----------------------------Rock Size _____ � r <br /> Distance to nearest: WeI - -__---__._.Foundation d___ :___ Prop. Line .. .............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---- ------------------------------ Date ------------------------ ---_----1 <br /> Septic Tank (Specify Requirements) -------- -- ----------- ` <br /> s �_b <br /> Disposal Field (Specify Requirements)-----.- = ------- ------- ----------------_--------------------------------------------------------- <br /> L _________+_________________________________________--- ------- --------- <br /> ______________---_______ ___________ _____A________________________.______.4________________________ <br /> r�7 <br /> --------------- -------------------------- -- <br /> ------------------------- ---------'.--------------------------------------------------------------------------------- <br /> Y : (Draw existing andzequired addition on reverse side), <br /> 1 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: r <br /> } "I certify that in the performance of the work for which this permit is issued, I shall not jemploy any person in such manner <br /> as to become subject to Workman's Compensation laws of California.'' <br /> Signed ------------ -------- = = ':--'-:.-- Owner <br /> By --------- - .. Title -------C-=. ---- 'r <br /> (if other than owner) <br /> t, FOR DEPARTMENT USE ONLY, <br /> If <br /> APPLICATION ACCEPTED BY ---- - ---------- - r�r � T- -----. DATE . '` ------- <br /> BUILDING PERMIT ISSUED ----- --------- ---- . --- _ I _.- _ T' DATE <br /> ------------------------- <br /> AQDITIONAL COMMENTS #-------------------------------------------------------kms~' <br /> _-----------------------------------------------------------=----------------------------------------€----'--------------------------------------------------------- <br /> --- ------------------1-=(-- ° <br /> • p i <br /> I ------------------------------------ ------------ ----------- - ----------------- <br /> Final inspection by-------------------- - -- / -- <br /> - -- ---�- 1-� --�---�-�------�------------- - ----------------.Date ---- ----'-'.�"�--J•-��-- ------- <br /> ""` SAN JOAQUIN LOCAL HEALTH DISTRICT— <br /> E. <br /> ISTRICT E. H. 9 1-'68 Rev. 5M <br />