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FOR OFFICE USI:: <br /> 1/ APPLICATION IOP. SANITATION PERMIT', ' *., <br /> ..................................................•---•-- Permit No. <br /> _. (Complete in Triplicate) ., <br /> .... ...... -------------- This Permit Expires I Year From Dot*Issued Date Issued ..F7,_ J&223 <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 /> JOB"ADDRESS LOCATION .. ..............CENSUS TRACT � <br /> Owner's Name ------- <br /> .����.'-/................................. .•._. ..................._....._....Phone ..��/'..��.71....._. <br /> Address ' <br /> ... city ...,�.t.�i���N�.................... <br /> 3 <br /> Contractor's Name ----- 1<' -- .:�__ ,L� ,���C.`".-- /�/t ..., ...License #1_.!/... *3-. Phone <br /> Installation will serve: Residences Apartment House 10 Commercial❑Trailer Court C3 <br /> r Motel ❑Other .............. <br /> Number of living units:...1__.... Number of bedrooms .... _.....Garbage Grinder A1.0.... Lot Size 17—.-................................. <br /> Water Supply: Public System and name <br /> ...--- I Private <br /> I. .. <br /> --------•.............. ......................................................................... <br /> Charocter of soil to a depth of 3 feet: Sand b Silt o Clay ❑ Peat❑ Sandy Loam fl Clay Loam M <br /> Hardpan 0 Adobe 0 Fill Material ............ If yes,type ............... <br /> (Plot plan, showing size of lot, location,of system in_relation to wails, buildings, etc, must be placed on reverse .side.) <br /> NEW INSTALLATION: (No septic'tonk or–seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK 41 <br /> ,5----- ................ Liquid Depth ---y.................. <br /> Capacity/c2049.---__ Type p �.� Material No.No. ,Compartments .X...............•.� <br /> Distance to nearest: Well ��G�......................Foundation _.. .......... Prop, bine _ <br /> ....... <br /> 11. <br /> LEACHING LINE No. of Lines --.--• ----- ---. XLength of each line------{ .............. Total Length _..,ere............... <br /> D' Box ,/VO--- Type Filter Material _ .Depth Filter Material <br /> Foundation --- ..r.--_...... .Property Line �. <br /> i r �• <br /> Distance to nearest: Well � <br /> 4 _._,/�.�.-_.... � � I <br /> SEEPAGE PIT [ Depth ...9-3_�..._ !'Diameter -2cz.... Number ......./I................. Rock Filled Yes,4 No 0 <br /> Water Table Depth _..,��'d� Rock Size -- - <br /> -/ -------_-------•--------- ................. <br /> Distance to nearest: Well ------A� . ..................Foundation ..,,lf...:..•... Prop. Line . . ........... <br /> 1,A <br /> REPAIR/ADDITION IPrev. Sanitation Permit# --------"-• ------------------------------- Date ._.....................4.......... <br /> SepticTank (Specify Requirerrients( --------------------•----------- --------•.........._..--------I...................-......................................._..-------•----. <br /> Disposal Field (Specify Requirements) --•-------------- ................ ----------------------------------------------------........................................ a <br /> --------------- ---•------------------------.--- ------------ - ......... <br /> -..-..-------------------------.-.. .-----------------......_------.-----•------------. ...._...................... <br /> 3 <br /> --- ----------------------------•------------------•--......----------_•--•--------..._--.._......_--•--........._................---,........._..........._.................__................. , <br /> f 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. Nome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance o.f,the.work for'which.this_permit-is Issued, l_shall not-employ any person in.such.manner <br /> as to become subject to Workman's Compensation .laws of California." <br /> Signed ----------- Owner ; <br /> --•-••-•----:---_------ Title -- --- .�: ..� _.. �. ... -- =-.. ................... <br /> (if other tVnoner] , <br /> 1117 FOR Dk ARTMENT USE ONLY yy <br /> APPLICATION ACCEPTED 6Y -..-- --- P Z. ..........:.... DATE ...., .;Z� ..._.....__ <br /> ILDiN PERMIT i5511ED _.. --•--- - ------. .......................DATE -------------- ................. <br /> ADDITIONAL COMMENTS _. }Yt�.[ � 2sowz __._1�i�C L�S�'ra '}� <br /> ................. <br /> ---- ZSR------•...................• - -----------------....----._.._..-----•-----...---......._ <br /> ------------------------------•- -------- .. ........... ---...............-•--•---.........._.._------ -----. ------- ------ <br /> Final Inspection by: __.... . . . Date .. ......... <br /> 13 2h . • SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N I <br />