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' FOR OFFId USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> .......................I�........................ (Compieteln Triplicate) Permit No. .Z.....9 <br /> f <br /> ..........................r ,� . ......... . This Penult Expires I Year From Date Issued Date issued.. <br /> .Application Is, hereby made to the San Joaquin Local Health District for a permit-1o' construct and Install the work herein <br /> described, Thl's application Is made In complioncb with County Ordinance No. 49 an exists Rules and Regulations: <br /> JOB ADDRE /LOCATION.............. :..... .1, ...... ._.. . ................:G.... ............CENSUS TRACT ....................... <br /> Owner's Name .........., -4::_ .rG.kn4F:5 ... .:........ .- ........... ... .......... Phone ..G... .../� L.:.. <br /> r .. on ............... <br /> t <br /> Address ..... ---.------ Jr��!2 .'. ........`.j......- °- .. ._ :City ..:./5 ii'.�. /l "� .. . <br /> Contractor's Dame _.__.. ,� .�.. -crl. ... -._ __..........................License pp;7' - Phone �1". .. <br /> 1� �; <br /> Installation will serve= N1,Residence❑Apartment-Mouse 0-Commercial C)Troller Court W ; <br /> - ,Motel ❑Other------ ............................. y1 , <br /> Number of living units=---...__•__--Number of bedrooms .-------: rbage Grinder _::. :-�LotSlie* .................................... <br /> Water Supply: Public System and name ............................._-- ..._ .-._......._.........: __ ... ............._...fsrivate� <br /> YI <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay.per Peat-o',j Sandy Loamy ..r Ciay Loam ❑ <br /> q Hardpan[I Adobe❑ FIH) aterial� -...... if s,to <br /> r .. ...... . . . ....... <br /> (Plot plan, sHbwing size of lot, location of system In relation,'to'wells buildings,etc./muat;be placed on reverse side,) ± <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted`if publ16 sewer-is available within 200ffeetj <br /> PACKAGE TREATMENT [.]�SEPTIC'TANK f 5#ze . '`...................., Liquid Depth ........: ............... <br /> jf <br /> '> ..... �•---- TYIe •-- k._lll[ateri F .••► No. Compartm nts -------------- <br /> Capacity � e - ..gyp <br /> Distance to nearest. Well <br /> F U..• )=Foundation :Prop, Line <br /> LEACHING LINE [ j No of Lines ------- ......... ..... Length of each Ilne.-----i-� ' _ "' Yotat Length ................. <br /> E <br /> Type Filter Material DeptbtFilter MOferlal <br /> ... ' :...... <br /> Disa nearest:ea�st: Well .............. J. Foundation ........ Property <br /> e Line ..............:.. :I <br /> SEEPAGE [ g Depth .................... Diameter._.- ._.. Number ....... ,_--... :... Rock Filled 'Yes No [ . <br /> y � 5 <br /> f <br /> Water Table Depth ............................ <br /> r............. ',dock Sias ..... .................... <br /> Distance to nearest: Well ..............ZN - -••_-_•--♦_•_•___....Foundation .................prop. Line ......... <br /> ............. ; <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ____!..............1_u1__.-____-_--____- Date .......... ... <br /> Septic Tank(Specify Requirements) ---• ............. _ -._•....... ......... .. <br /> ..... .............. . .. <br /> Disposal Field (Specify Requirements) .i✓. . . �. j.s ...... -...... ......... . -----._._..-- ......... - <br /> ................. !I�� ......----_-.......... -.---•-------•--------- ---._.... , A-11 '- <br /> . :.. ... . ..._..`.. .........- - <br /> .............................. ..- ---- - ---- ---._ _ _..--•--..-_......•..... ................. <br /> (Draw exist('ig and requiredAre <br /> addition on reverse side) I <br /> ),hereby certify that t have prepared this application and that the work will be done .in accordance with San Joaquin { <br /> County Ordin'nces,`State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen- <br /> ed agents signature certifies the following:/ , <br /> "I tern that��in the performance of the,work for which this permit is°issued, I shall no employ an <br /> fy P p p y y parson in such manner ;r <br /> as-to-become subject peW kman'- _mpe sation laws of�California." 3I1 <br /> Signed ....G• E' -" ~��-:�! ............. .._ .. Owner I <br /> B `f title ,• - <br /> y , <br /> (If other than owner( `" <br /> ISI FO EPARTMENT USE ONLY a <br /> APPLICATION ACCEPTED BY .. .... .............. .....::. ................... .......,DATE ... ..•.` - ...........:.. . i <br /> BUILDING PERMIT ISSUED DATE ........::.::...:.....:.................... <br /> . .....:......... ... ..._...._.......__..__.. <br /> ADDITIONAL';COMMENTS .....................................-............. .....__ .................................. ................................................. <br /> ------------------ --------- .--------..-•---•__....._...••-•--•-----•-•----.._.....------.--------...._....._.----.......--------••-..........._....----•--------------..........._..._.. <br /> ..:................:�_.......__....._._.:. ..................................... ......_................ ....................._.....-----'--.•......_ :_...._... <br /> FinalInspection by: ......................�/✓_..._... _. ._. ..----••---......_.. ._.......-_......_ ............. -Date ..... ............ <br /> Eli 13 24 1-60 Rev. 5M SAN JOAQUIN L L HEALTH DISTRICT $/'ja 3ltii <br />