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FOR OFFICE USE: APPLIGetION-OFOR SANITATION PERMIT Y <br />....................... Permit No. 7�'`�3 <br /> IlComplete.In Triplicate) <br /> ............................... ........ <br /> Thls Permlt Expires Year Irrom Date Ise^_ _...,_e I <br /> 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 /> r�NJOB ADDRESS/LOCATION .....I. "S .` ...._ .lY...................................................CENSUS TRACT .......................... <br /> v <br /> Owner's Name .... 0. �1p,� /���.... y--...._.................:.........y.�.�..,.,.�...J... ...........Phone ............_..._.. ............. F <br /> Address . <br /> .. 1. 6 ��----- .c.5'..__...U _46 IV----/ ... .... Cityc/o..... ...,. l <br /> Contractor's Name -------....... /� :%I� ..._.License #o5'7e. f Phone` s <br /> Installation will serve: Residence 0.Apartment House fl Commercial []Trailer Court 0 <br /> Motel ❑Other ............................................ <br /> Number of living units:.... Number of bedrooms ...PrGarbage Grinder ....._.. .. Lot Size . a / ................. <br /> Water Supply: Public System and name .....:.....................•..................................................................................Private <br /> Character of soil to a depth of 3 feet: Sand W Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Cloy Loam ❑ <br /> Hardpan ❑ Adobe.0 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: <br /> (No septic tank or seepage pit permitted If public sewer Is available within 200 feet, <br /> PACKAGE TREATMENT f ] SEPTIC TANK f ] Size................................................ Liquid Depth ---................._...._r ' <br /> Capacity ... ...... ......... Type ------------•/each <br /> Materia ..-••--•............_. No. Compartments ......................1 .. <br /> Distance. to nearest: Well .............. .......... ..Foundation ...................... Prop. Line .......................6 <br /> LEACHING LINE [ j No. of Lines ------------------------ Lengthach ine----------------------------- Total Length ............................ <br /> 'D' Box ............ Type Filter Materi ..... .......Depth Filter Material ......_-.................................... <br /> Distance to nearest: Well ........... ..... F undation _.....-_.._.__...__..... Property Line ........................ <br /> SEEPAGE PIT ( 1 Depth -------------------- Diameter -------- Number ..._.....-__.._____......... Rock Filled Yes ❑ No i❑�Water Table depth ------------- ------------- -.....---....Rock Size ..•-----------.._..........Distance to nearest:�Well -- -•----_------ ------ ------Foundation .--_..__._._____.... Prop. Line ......................3 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..._... •---------------- ---------- Date .................................. <br /> Septic Tank (Specify Requirements)-----------------------------------------------•--._...................... .-............I............... <br /> ..._.... <br /> Disp al Field (Speci#y Re uirements( --•-----•- ---- ------------------------------------------•------------------------------- E <br /> --------- n -------- c �i.1. . ,... ,� A---------/pQ6----- <br /> M cZY? ------.-- <br /> --- --- ---- .................. ........ <br /> (Draw existing and required addition on reverse side) _., <br /> I hereby certify that 1 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 Son Joaquin Local Health:District. Home 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, l shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> WSigned -•--------...•--- f - ---- ---------- Owner <br /> AL <br /> BY ------ -------- - - ---------- Title --- ------. ....... -------- ........................... <br /> (If o9ther a� ner( l <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEc BY _ -------- --_--------------- ------ -------------_: .........I............. <br /> . `,.._...._--_- <br /> BUlLDING PERMIT ISSUED -- -• ---- DATE ........................................... <br /> ADDITIONAL COMMENTS ------------------ - _... <br /> ---------------- --------------- ------ --------------------_----------------------- ---------------------------------­--------• --•-- ------- .......... -----------------------.._..-._. <br /> -------------------•------•-----------------------------------------------------------------------•------------------------- <br /> ---------------------------------- <br /> - - --..._ <br /> Final Inspection by: _. - -- - -•------•------ ------------•--......:........- ............I—---------..-Date <br /> EH 13 .2L 1-6th lZev. � SAN OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> f <br /> i <br />