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d. <br /> FOR OFFICE USE: <br /> PPLICATION FOR SANITATION PER <br /> ------ <br /> Permit•No. -�J <br /> x <br /> ------ ---•- m --- y <br /> ----------------------------------------- --------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a peri t c n lnstall .the work herein <br /> ' described. This application is made in compliance with CountyOrdinance No. i m es and Regulations: <br /> l <br /> JOB ADDRESS/LOCATION DC.L_1'M_t°!___,- f4iE'r►'Lr------7-- - - --- �--- <br /> �4• -0Y-- -- -.__CENSUS TRACT .S-�-7---•----------- <br /> Owner's Name � d --------------------------= -- ----Phone •••-- <br /> d c;tv .0- ---- �� r`f�---------=--- <br /> Address -3 �� J C* 74 - - ----- <br /> Contractor's Name --------- � 1 --------------------------License #- 2q_a_5_Z2 Phone',-- 3.6---?_y?6`6"G <br /> Installation will serve: / Residence ggA15artment House,❑ Commercial []Trailer Court ❑ <br /> Motel ❑Other ----------------------------------------------- <br /> Number <br /> ---------------- --------------------------Number of living units:____I-_ Number of bedrooms ___...Garbage Grinder ------------ Lot Size --------------------------_________________ <br /> Water Supply: Public System and name -----------------------------------------------------b----- <br /> �--------_-----------•----•---•--------------Private 9}_� <br /> Character of soil to a depth of 3 feet: Sand'n Silt❑ Clay att Sandy Loam ,E] Clay Loam ❑ s <br /> Hardpan g��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 tach-or-seepage pit permitted if public sewer is available within 200 feet,) C <br /> PACKAGE TREATMENT ,.[ ] SEPTIGTANK I]- -. - :d Size--- --------------------- Liquid Depth ---!G-"O-----=-,--_-- -� <br /> Capacity V00-Ji- Type Y S7Vlateria l---------------------- No. Compartments ---2.--.--.- <br /> Distance to nearest: Well __TS ----•--------------Foundation ___j_�..___________ Prop. Line ___3 0.......... <br /> - g k -2- -Q.--- <br /> LEACHING LINE . ( ] Na. of Lines � i'_":"-_.---__ Lon th of each line,.___�0_'__________- Total Length <br /> ! is <br /> 'D' Box ___1_____ Type Filter Material LI -MG(Depth Filter Material ____1 8 _______________________________ <br /> 1 yy / t <br /> Distance to nearest. Well __-_7{uQ.__ Found�atiorr-_-:161 _____.------- Property Line ........... \\ <br /> a - 3 ----------t_-�Rock Filled Yes No �J <br /> SEEPAGE PIT [ ] Depth �_ _____ Diameter _--� .___. Number _. _ <br /> Water Table Depth ---------------^2-_0.0--------- --------Rock Size __: -,2----­­-------- <br /> Distance <br /> ----•- -------- c <br /> !. I <br /> _Foundation _______ Pra Line .............:..... <br /> Distance to nearest: Well _-.__-- ----�Q......._._•-__-_-- -----= - p� --- <br /> REPAIRfADDITION(Prev. Sanitation Permit# -----=--------------------=----------------- Date -----,--------------------------=-) <br /> Septic Tank (Specify Requirements) --------------------=------------------------------------------------•------------------------...----------...:I.---------------•------. . <br /> Disposal Field (Specify Requirements) ----------------------_------ -------------------,--------------------------------------------- --------------------- ----•----------- <br /> ----------------------------------- ------------------ - ---------------------------------------- <br /> -------- <br /> __ <br /> (Draw existing and required addition;on reverse sie) <br /> I hereby certify that I have prepared thisapplication 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 Iicen- <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 lows of California." <br /> Signed ------- -------------------------------------------------- --------------•--------------------- Owner <br /> S <br /> l BY G�L� ---------------------- Title0?1 -7 <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ---------- •---------------------------------'--------- - <br /> ------. DATE.- / a - - 3--•---------- <br /> BUILDINGPERMIT ISSUED ----------------------- ----------------------------------------------------------------------------------DATE -----------•------------ -------- <br /> ADDITIONAL COMMENTS 9 ---=--------- •-•----------- <br /> _ r- <br /> ^ 1 .. r...r .. __ f- -- ` ------ ------------ --------------- ----------_-----._.. <br /> ----------------------------------------- - _ }° <br /> ------------------------------------------------ ------`--`----------------- -------------------------------------------------- ------------_------- <br /> --------------••-------------""•---""'-- _ ""-------'---•------- - _ <br /> Final Inspection by- -e £---------------------- -•-.--••--•-•---•---------=---------- - -----.Date - -------- -----•---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'f:8 Rev. 5M <br />