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A FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT -7 <br /> ...._......... ............................. ---•-• Permit No.T� <br /> (Complete in Triplicate! .. ..-f.. <br /> ......................................................... , <br /> Date Issued AZ7 <br /> .................-..............................._....... This Permit Expires 1 Year from Daft Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> descriZr,bed.-This application.+s ad in compliance ith County Ordinance No. 549 and a [sting Rules and Regulations: <br /> __ <br /> ' <br /> JOB ADDRESS/LO ATION . _ ..... _ 5...... ... U ! 4 <br /> �� CENSUS TRACT <br /> Owner's Name . 14e- ...... ............. .4�.�'��! � ......._Phone .......,._.._.. <br /> Address ----................�..D ` .............. ,..._.....--••----._......--••-......City --•-• ..... ................................... <br /> Contractor's Name .. _� ... .. ----- --- ....-•..................................License# _..._.... .............. Phone ....... --•--- ------------ <br /> Installation will serve: Residence 0 Apartment House)qCommercial❑Trailer Cocoa 0 <br /> Motel ❑Other <br /> Number of living units_______ ____ Number of bedrooms . Grinder <br /> .......----- ............ Lot Size .................. ------------------- <br /> 4 Water Supply: Public System and name ........................................................------- ....................................._.....Private <br /> Character of soil to a depth of 3 feet: Sand D Silt 0 Clay ❑ Peau Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe❑ Fill Waterial ............If yea,type............... ............ <br /> E? <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.S 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 <br />. � � [.]-- e Size----------------------------------------------.. Liquid Depth <br /> Capacity -leo--------- Type -_t�1f.��#------ Material... No. Compartments --`3,.___..--•- <br /> P <br /> Distance to nearest: Well -------10.01 f ..................Foundation .....AP............ Prop. Line ... <br /> LEACHING LINE [ j No. of Lines ........................ Length of each line............................ Total Length <br /> 'D' Sox ............ Type Filter Material ....................Depth .Filter Material ............................... <br /> Distance to neaFest: Well .14—MIM..... Foundation ------------------------ Property Line <br /> SESE-Pff- { Depth .--_- ..--.--.. Diameter .._..../._..... <br /> �.� . Rock Filled Yes� No iC <br /> Ti �� Water Table..,Depth ----------.�--....----------------------------Rods Size ,�.✓.�..;................... � <br /> t <br /> Distance to nearest: Well ..1.�?.4.............................Foundation .__--20..._...__ Prop. Line ...UP........... <br /> REPAIR/ADDITION(Prev. Sanitation. Permit# ............................................ Date .................................. <br /> ) <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) .........•-.......................................-...-=..............---•....................................................... <br /> .... <br /> ....-•---------------••----------------------------- ------------•---•---•-----------.......-.............-•.............................................. .................................... <br /> (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 San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hedlth:Dlstdct. 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, I shall not employ any person in such manner <br /> as to becomesubject toWorkman's Compensation laws of California." <br /> Signed _..._._Jf -•-------:------ --------------------- Owner <br /> BY - -----------------------------------------*------------- <br /> ---•-----------------••-•-- ••------------. Title ........ ------. ........... --------••---•----------._....- <br /> (if other than owner) <br /> FOR DEPART T_-VSF,T_—VSONLY <br /> APPLICATION ACCEPTED BYDATE ._._ ..................: <br /> BUILDING PERMIT ISSUED ---------.............................. ......... •--- - --------------- ------...............DATE :.•--................... <br /> ADDITIONALCOMMENTS ----- ---- --------------•--•-••- ...........................--.------------------------------------------------- <br /> --- <br /> ...-....._ <br /> ---------•----------•-•-•-- - <br /> --------------•-----------------.--.................-----------------------------------------------•..................- __._.. .. <br /> Final Inspection by- ------ -----------•---...---------------....--------------••........ <br /> - -------_Date ......!..- ?.7......................... <br /> EH <br /> 13 2 v, SAN JOAQUIN LOCAL I•EALTH I ICT $��� 3M <br />