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�. FOR OFFICE USE: 1 <br /> ------ AP, > Permit No. <br /> ATiON FOR SANITATION PERMIT / 73 <br /> -" -------- - --�---- - ------------------- <br /> (Complete in Triplicate) <br /> ------------------- ------------- <br /> Date issued ._7 ........... <br /> - <br /> ----------------------------------------- This Permit Expires 1 Year From Date Issued <br /> rplication is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> scribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> 108 ADDRESS/L T ON {� �' �- / �.�� _ft.:, c- r. , ; . CENSUS TRACT ---- <br /> nrner's Name „f �Y!".� �ll._- - -' <br /> lL - �'j .... Cit C /.--...-Phone <br /> .fdress ---_.. — ----- - ---------- -------- ------------•-- -------•------ <br /> Y <br /> R .�� icense # . �y . - Phone . <br /> -ontractor s Name .......... ,/�' t;/� C!..... %_.4. L <br /> Fstallation will serve: Residence ❑ Apartment House Commercial,❑Traiter Court ;❑ <br /> i Motel ❑Other ._.U.. C.. <br /> riember of living units:............ Number of bedrooms .---.._._.-.Garbage Grinder .......-_.. Lot Size -.-.---.........-..-------------------------. <br /> ater Supply: Public System and name ------------------ .a_l,6'" -------------------------------------------Private ❑ <br /> :haracter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam j] <br /> Hardpan ❑ Adobe [] FiII 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.l. <br /> F.W INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> ACKAGE TREATMENT [ SEPTIC TANK [ ] Size-------------------_-.._-_.._-...--...-....... Liquid Depth -..----------------------- <br /> Capacity ------- --- Type -------------------- Material------- .----------- No. Compartments - - ----------------- <br /> F <br /> f Distance to nearest: Well ------------------------------------Foundation -----------_-.--------. Prop. Line .-----------------.--- <br /> EACHING LINE [ ] No. of Lines - ----....... ....._ Length of each line- - -- -------------- ------ Total Length --------------.------------- <br /> 'D' Box --------..__ Type Filter Material --------------------Depth Filter Material . <br /> Distance to nearest: Well ------------------------ Foundation- -----------____---- Property Line <br /> EPAGE PIT [ ] Depth -------------- Diameter ----------- Number .------------.--------------- Rock Filled Yes ❑ No i❑ <br /> L,. Water Table Depth --------------------------------- --------------Rock Size ------------------------------ <br /> Distance to nearest: Well -------------------------------------_Foundation ._-.---------------. Prop. Line -------- ------------- <br /> f—PAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------.-----I <br /> •Septic Tank (Specify Requirements) ............. _- __- <br /> ------------------------- ---------- ----- ---- ------ -.------- -----------------c-------- --------------•--•- <br /> c... c 1 _c9----------------- <br /> Disposal <br /> Field (Specify Requirements} f_p'-p.s�r.4 JJ"-�, -t? '�r_:�' •.:.. ....---- <br /> -----� <br /> o. �. lysf.�... ,_�4 ......... f •--1--------------- <br /> F <br /> --------------------------------------------- - ---- - ---dd-i- ----- --- ------- -- ---- ----------------- ---------------------------------------- <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 <br /> F.ounty Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner-or licen- <br /> ed agents signature certifies the following: <br /> certify that in the performance of the work for which this permit is issued, Vshal€ not employ any person in such manner <br /> F to become subject to Workman's Compensation laws of California." <br /> igned - -- ............................. - ------------ Owner <br /> ��r...d.- •= ' - �_ , <br /> Tt e .._..,.,_f :.7t/-� ------- <br /> i <br /> (lf other than owner) (% <br /> FQR DEPARTMENT USE ONLY <br /> I ,'PLICATiON ACCEPTED BY <br /> Z�1( DATED..:- -. ._ /.-..✓--------•------- <br /> --=-- ---------------------------------- -------------- <br /> ',UILDING PERMIT ISSUED .---- ------------------------------------------- -- --- --...... --- . _DATE <br /> kDDITfONAL COMMENTS -------------------------------- <br /> -'------------- -------------------- - - - -- --` - ---"..." _ --------------------- --- ----------------- =--- ----=i------/_ - ................... <br /> :::final Inspection by: . -^ �c.t- - ='-_°: ., Date✓. f C `� <br /> _-. -- -- - -- . ............ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br />