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FOR OFFICE USE APPLICATION FOR SANITATION PIRMIT <br />......................................................... <br /> !Complete inrip!lcate! Permit No. 7 ::. °. <br /> .................................. <br /> ,,,,. .:_�_.....�.._ _ Date lssuad 3-3; G <br /> Phis Penult Expires 1 hear From� bate lisu�d <br /> Application is hereby made to the San .Joaquin Local Heahh`Distrlct for a permit to construct and Install the work herein <br /> described. This application Is made In'compll nce with County Ordinance No. 549 and existing Rules and Regulations, <br /> 2cco 'Q <br /> !OB ADbRESS/LOCATION 1.--...... ...1�1 ....................................CENSUS TRACT ........................ <br /> Owner's Name <br /> j�............rte ........... ............:.. ... ... .. ........................-........ ......... ............. ; <br /> address ..... t'• �1---..h. c� �7... ...........................City .... ..................................... <br /> Contractor's Name � ...................License # . ►- ._ ... . Phone ............ ..... <br /> Installation will.aerveis ` Residence*Apartment House] Commercial OTroller Court 0 ` <br /> ,. <br /> Mote!(]Other . ' <br /> Number of living units:.....-__... Number of bedrooms .... ...:Garbage Grinder ............ Lot.Size ._-,�s ...K_l.rj�........... <br /> Water Supply: Public System and name ..................................._... --._... __.-_ -.......................private <br /> Character of soil to a depth of 3 feet: Sand b Silt❑ Clay-0 Peat 0 .-Sandy Loam ❑ Clay Loam D <br /> �.n <br /> a <br /> ,Hardpan � Adobe fill Material ._.__::::: If ye:.type............... ............ <br /> t <br /> !Plot plan, showing size of lo-ti,location of system in relation to wells,. buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank oP Seepoge pit-permitted if public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT ( } SEPTIC TANK ze......: ....: :�._-_-.-.:... ::....... Liquid Depth ..+ .........------.. <br /> Capacity/�.. . ....... Type -:.... Material...�°d. -.. No. Compartments ---�•---------- <br /> Distance to nearest: Well �Q_ r .Foundation �.., ... Prop. tine �'c <br /> TEACHING LINE `� No. of tines .....:... ........... Length of ach line....:....�........ Tota! length .� ............. <br /> 'D' Box ...: .. Type filter Material .. .._.Depth Filter Material .. .. ................................. <br /> Distance to nearest, Well ...,���.f. ....... Foundation ...... 0... ...... Property Lime ............ <br /> p' '`� ..........f..... Rock Filled Yes No <br /> SEEPAGE PIT (� "� �e th ....� ..�_..__:.. Diameter .... .. ...... Number ....../.. <br /> !Nater Table.DeFith ................................................Rock Size 3 f�k............ <br /> I <br /> Distance to.nearest. Well ------- •--An................foundation ....1..Q— .... Prop. Line ............_...._... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ................... ... Date ) <br /> ;ieptic Tank (Specify Requirements) ......................................... .................................................................. ...........__...........-- <br /> D;sposal Field (Specify Require"ents) ................................................ .............................-......................................_...I.....---... <br /> ••........................ .;}................................................ .....__.._...............................--•-•----•------..................----............... <br /> ..............................................................................................-........................................_._...... ........................... <br /> is (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 Son Joaquin <br /> County Ordlnances,-eStat'a Laws, and Rules and Regulations of the San Joaquin Local Health District. Homo owner 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 /> .�nec� �............... _.. .... ......... -•-•-•--.... Owner <br /> (If �` r t6�an ownery -�..�.-�„ <br /> ------------------ <br /> By __.... . <br /> FOR REPARYMENT USE ONLY <br /> ` �• � 3 7 � <br /> APPLICATION ACCEPTED BY ..f�- .�...-..... .......... DATE :........ .....................:,......... <br /> BUILDING PERMIT ISSUED �. _ .DATE--:........-- .............. <br /> ADDITIONAL COMMENTS.....••-- ... - ......•... ........... ................................. ................. ..... <br /> Fye' _ _ _ _ __ _ _ _ <br /> ..............'X. ' ------------------...-----...... ..-.--.--------------------*...... --.----.......---... ...................... --------. ---- <br /> ----- -.... -.. .. ... <br /> -- <br /> Final Inspection by: Date �. <br /> _; <br /> -72 <br /> ..............................." <br /> ....... . :..:. <br /> EH 13 24 1-66 Rov• 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7h 3M <br /> -- Q3 ,, <br />