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H r G4.1C <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ........... r � <br /> (Complete in Triplicate) Permit No. .. ..._r.... -. <br />.................... ................. <br /> This Permit Expires 1 Year From Date Issued Date Issued 37�zw.nl/ <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> A,13 ,,f <br /> JOB ADDRESS/LOCATION .......- ... ... ........� .. ���...........:...-..............CENSUa TRAC) ..: :. 9,--..... <br /> L .�_ -.> .V �� ......i�.C� ...._ .,_'.. ...Phone.. ........ ............,...... <br /> Owner's Name ........ -- •• :. ...... . <br /> Address ...... '� ...... -......t 1- C[ f�. �. :.:.......:.... City El.:�= ..........-- -•--....................--- <br /> Contractor's Name .............joL1 /)f ...... .............-........................ A# ...i ....'Phone .............................. <br /> Installation will server Residence �rtment House 0 Commercial'OTrallar Court ] I <br /> Motel E]Other ..:.......... :...:X..... <br /> Number of living .units:.. — .- %,[Number of .bedrooms `-3.....Garbage':Grihder� Lot Size .....CR���r�.............: <br /> cr l _ . <br /> Water Supply: Public System and name ...............................•-•-------._ ...........................--------------- ----•------ .......................... --..Private 94--' <br /> Choracter of soil to a depth of 3 feet: Sand❑ Silt o CI0V-�0 Peat❑ Sandy Loam C] ;Clay Loam <br /> Hardpan [ Adobe.16' Fill Material '-- . .... If yes,type ...... ...........:....: <br /> S <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 seep a pit�permitted`if'p blir-sewer i3 available within 200 feet,) �+ <br /> PACKAGE TREATMENT E J SEPTIC TAMC 1� { Siae: �.-........ Liquid Depth .. ---- ------ --- <br /> Capacity ..� - -•_-- Type p. Material. t �I�` T�io. Compartments ...................... <br /> (stance to nearest: Well .......�..` �::.........Foundotlon ..:`f4 0-4--_ Prop. Line ...5_.` ..... <br /> _.: � .. r <br /> LEACHING LINE { No. of lines ....-.�—.-------- length of each line.....�---.-......~:.•••.�Total ,Length ...� .............. � <br /> /� f <br /> 'D' Box -!�.� Type. Filter Material ,C� .,Depth Filter Material .-:.1�.................................-0 <br /> Distance to nearest-Well ...:,.7 �...__'#`j foundation ':. ...::......:.. Property Line .- ......... ... ...... <br /> SEEPAGE PIT [ Depth ./. -..-.,___.DiameterY X-K..•"Number ... .-- -_.... ... Rock Filled Yes No 0 N <br /> • Water Table Depth--._.....01• 5- .........f ,.. .... .Rock Sire ., z.-. 1Z_ + ' <br /> .. ..,,.. <br /> -,� <br /> Distance to nearest. Well �Q ... ....................rFoundation ..".1 Prop. Line .........�.__. <br /> / (Prev. . 'bate ::...... : .. P <br /> REPAIR ADDITION Prev. Sanitation Permit# " ' ''_. 1 <br /> Septic Yank (Specify Requirements) .... .. .` � � x' ' <br /> 4 .. - <br /> Disposal Field, jS cify Requirements) .............••---......•-•-• ----••••••----------....................• ---_.............-- ..........•.. .......... ....--------- <br /> 1 . <br /> _........ Y ........ ....................... ..•-- --------......._.... .....-•----•---•--••--------..._.............--••-•------ <br /> ... •--• .. .. <br /> (Draw existing and required addition on reverse side)( <br /> 1 hereby certify that I have prepared this application and that the work will be done in, accordance with San Joaquin <br /> County Ordinances, Slate Laws, and Rules and Regulations of the'Son Joaquin Local Health District, Home owner or licen- <br /> I sed agents sig -lure certifies the following: <br /> "I cerfi a the pe orma to of the work for which this permit is issued, I *hail not employ any person in such manner <br /> as to cam subject Wor a 's Coensatlon laws of California." a <br /> Signe . .��.................. . .. ---•-•--•--.........:...------............... Owner �- �'�•}moi - <br /> By ..-........... .............. .............................. - .4.. Title .......... N\`F..--.........-..............................__...... <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ........Cl:R.'.C1i............................:.............................................. DATE .:. -.. . <br /> BUILDING PERMIT ISSUED tee.................. �... ._ DATE . <br /> -----...... .. ....... <br /> r ADDITIONAL COMMENTS ' -A !`��`!l !�...� :' - s �!`? .r�rp e? ..........?!P.:..................:...........•............... <br /> ....:....::.....-...::............--:— ................................. <br /> .... .:l_................................................. <br /> ... .i�.i�, ... ...�.• ... ;�=J ... :::......-:::........: .....=- . <br /> _ . X. •----• <br /> .._._.....-- '_.... "•� y=_. - - - ::...,T�'. . ......... ........ . ...... ----- .. .........................`..= <br /> -Date <br /> Final Inspection by: ....:...... ---��:�"---•-----•............................................................---------. �::-......_�•�..................... <br /> _ SAN JOAQUIN LOCAL HEALTH- DISTRICT <br />