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F <br /> PALE COPY <br /> FOR OFFICE USE. j FOR OFFICE USE: <br /> V APPLICATIOi,l FOR SANITATION PERMIT <br /> -7�- 9v <br /> (Comslete In Triplicate) Permit No. <br /> �? Date Issued <br /> ••-• .. .-' -- This Permit Expir is I 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. 544 and existing Rules and Regulations: <br /> r JOB ADDRESS/LOCATIO - ...�.7C1 �TMfl�•� +���� CENSUS TRACT <br /> g .............. <br /> e.. r .... .- PhoneOwner's Nam <br /> Address......... . .... . -N-C City <br /> Zip ... <br /> .. . .... <br /> Contractor's Name-....... .ire- !�'... fs . -.-.G.�,t License Phone <br /> Installation will serve: Residence 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 Loom ❑ Clay Loam (] <br /> Hardpan [j' 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 /> NEIN INSTALLATION: (No septic tank or seepage pit permitted if publ;c sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { I SEPTIC TANK j j Size Liquid Depth G <br /> Capacity ...... .... . .. . Type .. ... Material ..No. Compartments <br /> Distance to nearest: Well . „Foundation Prop. Line p <br /> LEACHING LINE [ ) Via,o. ,Typ <br /> Lines e..,.... Length of each line Total Length .. <br /> Filter Material. ... ......... Depth Filter Material.. .. ........... ... <br /> Distance to nearest;Well............ ... . . Foundation . . . Property Line _.,......._...... ' <br /> SEEPAGE PITDeth ... ... ,.-p .....Diameter . . . .. . ...Number ... ............. ..... Rock Filled Yes ❑ No CXO . <br /> Water Table Depth................. . .......Rock Size. <br /> Distance to nearest: Well.. ... . . . ................ ....Foundation .. .. ...... Prop: Line . ...... ................. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.................._.. ____...................Date . . .. .: .. .. . ... ......... ) <br /> Septic Tank(Specify Requirements)_- ... ..... ....... . .. ... ................................. ...... <br /> Disposal Field (Specify Requirements)...•..r�-rlct. .� .,-�'+ f��... t t,� .^.,. r✓" _, ,.._................v....... <br /> ....................../.....---.--. ....x.. .�r...., ...,.. ». f...... ...-,.. . .. <br /> ..-•••.......................................................................................... ..............................................._............. ..... .._. . ......... <br /> (Draw existing and required addition on reverse side) <br /> her4by.tertIfy that I have prepared this application and that the work will be done In accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> slgeahtru comfles the following: <br /> "I cerNfr 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 subject to Workman's Compensation laws of California." <br /> 510ned..... i /", l.. Owner <br /> �� �� <br /> BY...... ...... ....... .................. . vr�+M..... .. !tt Title. <br /> Ilf other than owner <br /> FOR DEPARTMRNT USE ONLY <br /> APPLICATION ACCEPTED BY, — <br /> 61visioN OF LAND NUMBER fff <br /> ADDITIONAL COMMENTS-. ... .. .. _. . . - DATE . . ... . , . . <br /> .... ...... ...... .. .. <br /> ,. .... .4-71 <br />