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FOR OFFICE USE. a p <br /> Pnl TION FOR SANITATION PERMIT <br /> - <br /> ................................. Permit No. .. : :_3...... <br /> - ,�Campiete in Triplicate) -- - <br /> ����?.3 <br /> ------------------------- This Permit Expires 1 Year From Date Issued Date Issued _..- _._. <br /> 1 r f <br /> Application is hereby made to f n Joaquin Local Health District for a permit to construct and install the work herein <br /> m <br /> described. This application is a in colance with County Ordinance No. 549 and existing <br /> Rules and Regulations: <br /> _ty F ..-..1 ..: .� .� fO".". .0 N � � ACT ....................... <br /> „ . .......... <br /> _ � .. SU TRACT ..... ......... <br /> JOB ADDRESS/LOCATION y-,-„-.•�".� -_ _ r � -•.••••��"���� <br /> Owner's Name _ .l 1./.�/......_.'. /� -•--..._.... . Phone ... . <br /> . <br /> Address ...........�_.:... ;.- :dy ,a. r .lam✓,✓ -J�..................... City ...._.... ................. .......... --:... <br /> .. <br /> Contractor's Name... .._. .. ..' .�... ` f ' License # / , ... PhoneeN '- . <br /> y <br /> Installation will serve: Residence rtinent House❑ Commercial '❑Trailer Court a <br /> ; <br /> Number of livingunits Number Na .Mote) ❑Otlier:... <br /> /rte <br /> ' �. I 's _-- orbage Grinder .. lot Size ---:✓Y/_ ...��... <br /> Water Supply: Public System and name r dr om .private ❑ <br /> Character of soil to a depth of 3 feet Sand❑ Silt❑ Clay Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> i - <br /> I <br /> Hardpan-[] AdobeFiil Material .:,4/. If yes,type ------_--------------_:... <br /> {Plot plan,_showing�size.of_lot, lacgtion -of •system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> a + II <br /> NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is available within 200 feet,) O <br /> PACKAGE TREATMENT [ ] SEPTIC TANK fes' Siare. ..................... Liquid Depth .. .. ..._.-._.__.. <br /> .. <br /> Capacity • ,� ��•-- Type f(' 4Aaterial ll "1Va. Compartments ...... �,........... N <br /> Distance to nearest: Well ,'/� � <br /> =T � - ........ Foundation .. Prop: Line ....... <br /> LEACHING LINE [�}-o. of Lines _-_-. r7---... Length a each line. •a '� .----•- Total Length /e? ............ <br /> r <br /> D' Box _tl Type Filter Material ------ ......Depth Filter Material - ........ <br /> Distoncego inearest: Well .'��` ___..... Foundation <br /> ....... Property Line ................... V <br /> ... <br /> SEEPAGE PIT- Depth, ___. Diameter ...... Rock Filled Yes <br /> - �;�.......: ��----- Number ...���. 42---Na 0 <br /> Water al rP _••--..... ..................................Rock Size .. -�-----f. <br /> • <br /> Prop. Line ~/.._. <br /> ...Distance <br /> tonearest: Well ..... Foundation <br /> REPAIR/ADDITIdWPrev. Sanitation"Permit t# .......-_...3 ........................ Date .......................... <br /> Septic Tank {Specify Requirement`) .................. ------1__ C <br /> Disposal Field (Specify Requirements) ------ ------------------=---•••-_--•••----•--=•._..__.....-•--...................---......................... •-.................. <br /> + . <br /> - I - <br /> ............................................-....................... ------ ----- • : <br /> --------------------------------------------­....... ............................. <br /> -------------------•--_. ...... -•-•-------------------------------•----------------• •--------------------- ----•---------............. ....................... <br /> (Draw existing and.required addition on reverse side) <br /> 1 hereby.certify-tha`F. 1 have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- <br /> sed agenir'signature certifies the-followin�c rim, �w_• <br /> "ll certify that in the perfoimance 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 __..-..__... [... -... - Owner <br /> BY <br /> c <br /> ..:........... <br /> (if _...... <br /> oth r th owner) # <br /> t <br /> FOR DEPARTMENT USE ONLY. <br /> APPLICATION ACCEPTED BY -----:C•• - - ':--- '----------. DATE .. .. .. . 3..----.... <br /> BUILDING PERMIT ISSUED ........... ......................11 . ........ ........ <br /> :.....- ----•----- ----------................:................................,......:.................... <br /> ... <br /> ------------1.------------------- . <br /> ................................ ......................... ........... ..............•---••-........-•------------------......_......-----...... <br /> - <br /> Final Inspection by: ___:... .....Date <br /> . .. .. � �SAN.JOAOUIN.LOCAL HEALTH DISTRICT <br /> o u 13' 24 1_'AD De., AkA . 7172 3 M <br />