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r-"[ UrrR.e UM ;W s <br /> APPLICATION FOR SANITATION PERMIT <br /> ..................... -----------------•------ - <br /> Permit No. .7 .._ <br /> iComplete in Triplicate) ..._._ <br /> ..... This Permit Expires 1 Year From Date issued Date issued 7. <br /> Application Is hereby made to the San Joaquin local Health District for 4 <br /> PP Y R permit to cahatriict and Instal! the work hereto i <br /> ' described. This application is made In compliance with,County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .,v�?S..�U.�...,r�L - �...... � /���.tt�....................CENSUS TRACT .......................... <br /> Owner's Name 100,1V ..... .�,. . ... .� .............. ............Phone .60(e 6 / ........ ` <br /> Address � .4 / �1.... 1�1�'G ?.2�/✓�. dt.,f........................... City .... !!UC J.........._._...................._ <br /> Contractor's Name ----------- .......... ........................._..................License# ........................ Phone ......... .............. <br /> Installation will serve, ResidenceXApartment HouseQ Commercial OTraller Court 0 <br /> Moteixother <br /> Number of living units:---..Q . Number of bedrooms .... �.../. GarbaOge Grinder .......... Lott$Ise .....�1..�....C�:; ...... <br /> Water Supply: Public System and name ....AL J!P? ,17- jet", j.__4ddlfr I� A4,Y. Pr � <br /> . .. .. ..--••�.................... wale❑ <br /> Character of soil to a depth of 3 feet: Sand t( $11t Clay j3 Peat❑ Sandy Loam 0- Clay Loam [] <br /> Hardpan I] AdobeFill Mpterlal ............if yes,type. ...... ............ ! <br /> • *- , <br /> iPlot plan, showing size of lot, location of system in relation to wells, buildings, etc.•must be placed on reverse side.) <br /> NEW INSTALLATION: IN* septic tank or seepage pit permitted if public sewer is available within 200 feet,l S <br /> PACKAGE TREATMENT ( SEPTIC TANK <br /> � Size. Liquid Depth � <br /> Capacity ��� Type !.f^`f.- 11. Material-: �+11l. :.. .'No. Compartments ........... --... <br /> Distance to nearest: Wellfd..i:......Foundation . .. Prop. bine ... <br /> •-•-• ��........ ... r <br /> LEACHING LiNE No. of Lines ........ . ..... Length of each line. .: :..-.-.. Total Len tis .. :.... f <br /> 'D' Box ... : .. Type Filter Maters i. ehiUA� pth Filter Material ..:...����.�,� ....:f <br /> Distance to no-acest. Well .. ........ Foundation .� . ........... Property Line . . ... <br /> SEEPAGE PIT X Depth VI <br /> ........ Diameter, :. ..:...... Number ........ ........... Rock Filled Yesi� No (] <br /> VIe— <br /> Water Table Depth <br /> .......................................... Rack Size ' <br /> 4nDistance to nearest: Well ........................................Foundation'.'... ........ ....... Prop. Line ........ .. .... <br /> REPAIR/ADDITION iPrev. Sanitation Permit# ........................................... Date ................................ .I y� <br /> Septic Tank (Specify Requirements) ..... ...........•--.................. ...................... .....:.................................. ..........._.......,...... <br /> DisposalField iSpecify Requireri ents) ................................ .................................................................................................. <br /> .. ..-....................................................................................................................................................................................... r <br /> i <br /> ................................................................. ......... ..................--_•. ... <br /> (Draw existing and required addition on reverse side) r ..t................ I. <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 Sion Joaquin Local Health District. Home owner or Ilan- <br /> sad 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 M such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> S.gn <br /> $Y .........I.i.. ...... h........._.. . .... <br /> ...... <br /> .----------- <br /> ................................ Owner <br /> .................................................... Yitle ......' <br /> ..................................................................tan ownerl . <br /> cther, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 13Y,,-.... ...... �.. <br /> G - .............................. %...................-.. DATE .. .. .,fi. <br /> BUILDING PERMIT ISSUED ........ -_ .............. _ . <br /> ADDiTI NAL .........................DAT �. <br /> .- CO ENT :..� ............ _..._ - .....�c� �i���j <br /> .............................'..--- ------...----- .. ..... <br /> Final Inspection by:..:...... .................................................................... Date...... .......... <br /> 13 ?h 1'bpi H°v,' $fit SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />