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,FOR,OFFICE USE: - �7� �Q�4D <br /> ,, _ <br /> Ir APPLICATION FOR SANITATION PERMIT ~.• <br />.............•--............................. - <br /> (Complete in Triplicate) Permit No. .-7q/./'-�.�`?�5.. <br /> .........................._...---. - 3 7y <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> ----------- --------- -------- -------- <br /> -.p ........---. <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 /> ma E of an 1� s de of Woodbrid e 2n 41)601d d- Rd' <br /> JOB ADDRESS/LOCATION ... _.... •.....-.....99 ----------- •.. ......... ........._.---- g--.CENSUS TRACT ...-------•--•---.... _... <br /> Owner's Name lcher .l..Omega Const.. ....Phone ...3b9Z783_.. <br /> Address P.O. Box...849.._..Lod ., Oa'--•-•........ ........... City <br /> Contractor's Name .....D,A, ,Parrish-&--,Sons_ : _Inc.-------- -_-..License # .254343_.....__ Phone -_?�-0607__....... <br /> Installation will serve: Residence M Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑ Other .. . ......................_--------- <br /> Number of living units:... Number of bedrooms _.(2)----Garbage Grinder ..... Lot Size -...,175..X...�90_.Feet.. <br /> Water Supply: Public System and name ---------------- ----------------------------------------- --------------...............Private <br /> Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam XX Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ......__ If yes, type .................. ......... <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. 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 XX Size----5X$................ . :......... Liquid Depth ......... <br /> Capacity 4-20094 - Type Pre-cast._ Material...Cancrete No. Compartments ..... ...... .. <br /> j_`- •-� t <br /> Distance to nearest: Well .. 60........... .............Foundation ....10.t.....-...... Prop. Line ..25...... ------ 00 <br /> LEACHING LINE [ ] No. of Lines (2) __.. Length of each line ....W, _ Total Length ...x6.0 t <br /> 'D' Box ..C.on.. Type Filter Material 14't_rpCk.-Depth Filter Material -1911..................................... [r <br /> Distance to nearest;,Well-65.................. Foundation t �..Z. ertline <br /> ...._. Propy ...•.20i___...._.._. <br /> SEEPAGE PIT [ Depth . . ... Diameter ---------------- Number ............. Rock Filled Yes ❑ No Q le <br /> Water Table Depth --------------------------------- ..............Rock Size -- .----_-_-_------ <br />'4 Distance to nearest: Well .._...•.................................Foundation -----.---... ..... . Prop. Line ...................... go- <br /> REPAIR/ADDITION <br /> .REPAIR/ADDITION(Prev. Sanitation Permit# ........ ................................... Date .................................. <br /> Septic Tank (Specify Requirements) .. -- . -- ------._ ---•----------------------------------------------- ---------....._..................................._........ <br /> Disposal Field (Specify Requirements) ........................................ ---------------_---._..!,:............. .. _-- ------------- ..................4 <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 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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ... ................................................. ...................................... Owner <br /> By ... Miles..A.-..Parrish Pres,,. Title . . ............... ....... . ....-- <br /> (if other than owner) <br /> FOR DEPARTMENT, USE ONLY <br /> APPLICATION ACCEPTED BY ...... ...... -----................_ .---.-. DATE ..._ ........ <br /> BUILDING PERMIT ISSUED .................. ..... --•-------...-------------------------•---....--- ._ ... . . ... ..........DATE .............. -----....... -------------- <br /> ADDITIONALCOMMENTS ------------------ -----------------------------------------------------------.........._...--•-• ............. ............. .......... <br /> -------- -•--------------------------•-----•----•- -- -------------------------------- ------ --------------.......... ..................................................................... <br /> . <br /> Final Inspection b -- 1�...--•---------------------------------------- ..--------------------....-•-..Date ---.. _l.w 7,4,e...... <br /> y SAN JOAQUIN LOCAL HEALTH DISTRICT <br />