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� T <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLIC-ATION-*130R SANITATION PERMIT q� <br /> -------- --------- ----- - Permit No. 7�- <br /> (Complete in Triplicate) ----1-- <br /> Date lssuedIT-,�_ __ -?;7 <br /> ••--•--------------------------------------------- -- -- This Permit Expires 1 Year From Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOTION-------------------- !�/ L <br /> �►' - ------------- ---�----- --------------------- - -----------CENSUS TRACT---------- -- ----- <br /> Owner's Name.. .Ue----- ------Phone-- ---------------------254 <br /> ------------------------------------------------------- �------- <br /> Address__r p -1" f��` ��/ <br /> � City -----------------------ZiP ----- <br /> Contractor's Name om....... � - -------- - License # 'G0��---Phone__9z3J ✓�. <br /> Installation will serve: /✓ R s' ence_V Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other-- --------- ---- ----------------- <br /> Number of living units-----------------Number of bedrooms.*-____..Garbage Grinder------------Lot Size-------.--------.-----.--.-_._.___.____---.--.----.-----.__- <br /> Water Supply: Public System and name----------------------------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam Clay Loa ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material.. ---.-----If yes, type. ?� <br /> (Plot plan, 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 TAN <br /> Size. Liquid Depth. ------------ <br /> ' Capacity_ 4? e-- ..Material--------------------------No. Compartments----- --------------------� <br /> Distance to nearest: Well../,AO_------------------------------Foundation-f ---------------------Prop. Line_e��.l---------___--.4�1 <br /> LEACHING LINE ] ] <br /> j INo. of Lines-----------------------------Length of eac line------------------------------Total Length._______---.----.--. ---------- <br /> ` ? jD' Bo --------_Type Filter Metria)_ ------__Depth Filter Materia -.7. 1 W ------------------------------------------------ <br /> J <br /> _________________________________.---.----- <br /> J- De -- -___1---------------Foundation ------------- Line <br /> Property Line.-----.-----------------------____-. <br /> SEEPAGE PITf ❑ <br /> [.� Depth Diameter* y ; Number <br /> --- Rock Filled Yes ❑ No <br /> ' Water Table Depth` ------------- ---------------------- ----Rock Size------------- �1 <br /> Distance to nearest' ell_+ LL�^ __Foundation------------- Pro <br /> I -- . ---------- P. Line----------------- <br /> REPAIR/ADDITION (Prev. Sanitat 6n Perm #-------- ----------------------------------Date .--------------------------------------------) <br /> Septic Tank (Specify Requirergents)--- -------- - _ ----------------------------------------------------- <br /> OP - a <br /> ter°: <br /> rf r> r <br /> Disposal Field {Specify Req+yirements) ------------------------- <br /> �*�I � <br /> ------------------------ <br /> -------------------------------------------------------- -_-----------------------------------------------------------------------------------------__---- --- --------------------------- -------------------- <br /> ;' (Draw existing and required addition on reverse side) <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and -Rule_and •Regula.tions -of�t}�e San Joaquin mLocal,Health District. Home owner or licensed agents <br /> 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 as <br /> to become s�ubject to Workman's Compensation laws of California." <br /> Signed- Ctt - Owner <br /> ---------------------- <br /> By--------------------- -- - -- ----- ----- ----- --- - -- - ---------------Title_- r <br /> (If other than,owner)4 , r.• 14, LN <br /> FOR DEPA &JE T USE ONLY <br /> �. <br /> APPLICATION ACCEPTED BY------ --------- �- � -- -----=--�---.--.-------Y--------------- -------DATE -------- <br /> DIVISIONOF LAND NUMBER --- ---- --- ---------------------- ------------------------------------------------ DATE.------------ --- ----------- --- ------ ------ <br /> ADDITIONAL COMMENTS <br /> ---------------------- --------------- --------------------------------------------------------------------------------------------------------------------- ----------- <br /> ---------------------------------- --- <br /> ------ - ------------------- --- --------------------------------------------------- ------------- <br /> Final Inspection by:------- -- <br /> -- -- - -- -- --- -- - - -------------------------------- <br /> EH <br /> ----- -- - --- ------------ ---Date ---- ------- �-- <br /> EH 13 24 SAN JOAQUIN LOCAL HEAL H DISTRICT ras 2167�i REI. 7176 3M <br /> R <br />