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FOR OFFICE USE: <br /> .- APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..7`. :�/ <br /> ............::_ ..........:........_..._�/__3.a..'. . :�yQ.._��// <br /> !� (Complete in Triplicate) <br /> ........ ....................... <br /> .____ .. This Permit Expires I Year From Date Issued Date Issued ..3. .�y. <br /> l Application is hereby madellto 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 /> JOB ADDRESS/LOCATION P.I-11 - _..�I..'..' 1. ...'.- 3? i ..CENSl1S TRACT <br /> ' . � ? . <br /> Owner's Name ............ ..................................................................Phone ....7.: �.? .. <br /> Address --------- r1'i l City .... . <br /> Contractor's Name •- ._b_.1WR.y"�:....elt Ezr, :�`.._f � .... � >.... -----..License - ;? .' :: Phone ...: :: .... <br /> �6 1 <br /> 4 <br /> Installation will serve: Residence OApartment ........F1 Other ..._..f__— -----•- <br /> Number of living units:____ . Number of bedrooms Garbage Grinder ------------ Lot Size '.............��- = <br /> Water Supply: Public 5 stem . . �------- � �^ '_..--••--------•-•--•-•---- <br /> pp Y Y <br /> 1�ond name ----------.•.......................... _......._.. .---.........._._._Private <br /> Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay [g Pegt❑ Sandy Imam O Clay Loam 0 <br /> Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type ............................. <br /> II, <br /> (Plot plan, showing size of blot, location of. system in relation to wells, buildings, etc. must be placed.on reverse side.), <br /> NEW INSTALLATION: (No aseptic tank or seepage pit permitted if public sewer is available within 200 feet) <br /> PACKAGE TREATMENT [ ] I` SEPTIC TANK Size_..I�­2C-- <br /> __------------------------ Liquid Depth s <br /> I <br /> Capacity .f ':rj Type ... Material.. No. Compartments ......... t <br />! it —.1 O <br /> fi � <br /> Distance to nearest: Well ..-. - .......................Foundation .............. ............__ Prop. Line . ...... <br /> LEACHING LINE [ } No. lI 6f bines ............ Length of each line.____.-5`............. Total Length .1.7t................N <br /> I ,r <br /> D' Box ............. Type Filter Material .. `°. .....Depth Filter Material .-, . ........ ...........1 <br /> Distance to nearest: Well ......1:.0 ....... Foundation _. .............. Property Line .:�_'........... <br /> SEEPAGE PITDepth ---.9.?,7------ Diameter ... ........ Number -----c1................. Rock Filled Yes)n No 0- <br /> Water Table Depth .......... .....1 .......... ..........Rock Size ...... ?:.... ---•-•. <br /> Distance to nearest: Well .................. Foundation ... ........ Prop. Line ----7:.-••..............� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _._........_._.--_.......................... Date ..................................) A <br /> SepticTank (Specify Requirements) ................................•• ..................................................... •--------...-----------•----...................... <br /> DisposalField (Specify Requirements) ..........................................-.............................................................................. -----•----- <br /> ..........................................----------------------------------------- ............--------- ................................................. <br /> I� <br /> t (Draw existing and required addition on reverse sidel <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 Health District. Home owner or lican- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I &hail not employ any person in such manner <br /> a9 to become subject to Workman's Compensation laws of California." <br /> Signed . r .. .. II. .._.. . Owner <br /> 8y ...................... _----......._ .__.4..__.� �,.�..'i'i�`:�.......................•-------- Title -----ff ................................................ <br /> (If other than owner) <br /> I� FOR DEPARTMENT USE ONLY 4 <br /> APPLICATION ACCEPTED BYy,\. .. . DATE ...... 9.................... <br /> -•------------------------ --•--•----•-•• � <br /> BUILDING PERMIT ISSUED ..................DATE <br /> ADDITIONAL COMMENTS .-yypp`y`�-------------------------- - <br /> . 1. '.1 ... .. .. .Gid. .............. -•-----------------•--•-..............................--...........---............... . ............. ------• F <br /> FinalInspection by: . �...........................:.....................................................................Date .......1................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT C , <br /> 1 <br /> -.E. H. 13 241-'68 Rev. 5M _o-0/72 3 M <br />