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FOR OFFICE USE: <br /> .'s (),APPLICATION FOR SANITATION PL. AIT <br /> -------------------------- --------- Permit No. <br /> (Complete in Triplicate) - <br /> F --------------- This Permit Expires I Year From Date Issued <br /> Date Issued <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 /> .Appx. 1050' So. of Harney Lane ora the <br /> JOB ADDRESS/LOCATIQN _.has-t---S-lde,--�f---6u x y----Ro-a d- bo-d z----- ------------------------CENSUS TRACT -------------- ----------- <br /> Owner's Name ...JAP---44 1-nCh-e1X--------------------------------------------------------.-------------------------------------Phone .----------------------------------- <br /> Address ---------------1_999---- <br /> e-------------------------------------- City _tD_cktoa <br /> Contractor's Name .---2g-to- -RaO-te-r---Sew ---S.erti� c ------------------License #1692-92---------- Phone - 5_ .-251b-------- <br /> installation will serve: Residence ®Apartment House-(] Commercial ❑Trailer Court [] <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:._1________ Number of bedrooms _____3_____Garbage Grinder ___f1o____ Lot Size ___10-0---x---30-0__________________ <br /> Water Supply: Public System and name -------------------- ------------------------------------------------------------ ---------------------Private <br /> ' <br /> iCharacter of soil to a depth of 3 feet: '❑ � $ ❑ Clay C] Peat <br /> Sandy ® Clay Loam <br /> Hardpan ❑ Adobe '❑ Fill Mate al ___:n__olt yes, ---------------------------- <br /> (Plot <br /> ---- -------------------�-- <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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size---- --_b_Y_•-1 -------------------------- Liquid Depth ---4.2.`_---------------- <br /> Ca <br /> Capacity 1 00 Pr--e--alp Material__Concret_e No. Compartments ____Z............... <br /> P tY 1 0 TYPe P <br /> Distance .to: -Meares#: W9ll ----------a0_r--------------------Foundation ----1-0-#----------- Prop. Line __R-1-------------- <br /> [ ] 3 g 80, dotal Length _____ Da <br /> LEACHING LINE No. of Lines :______________________ Length of each line.__.______.__ _ .__._ <br /> -'D' Box ____ c,�s_ Type Filter Material _1e' ro-c14_Depth Filter.Material _____l-8It-------,------------------------ <br /> Distance to nearest: Well -------- 0..._________ Foundation ---1-0_t----------_--- Property Line. _______,._-__- <br /> SEEPAGE PIT [ ) Depth -------------- ----- Diameter ---------------- Number ---------------- ------ hock Filled Yes 0 No � <br /> Fu Water Table Depth <br /> --------------------------------------- --------Rock Size ----- ------------------------- <br /> Distance <br /> - ---------------------Distance to nearest: well ----------------------------------------Foundation :------------------- Prop. Line -------------:-------- <br /> REPAIR/ADDITION,(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------._--..-------) <br /> SepticTank (Specify Requirements�-------------------------------------------------------------------------------------------------------------------------------------------I ! <br /> DisposalField_ (Specify Requirements) -----------------------------•-------------------------------------------------------------------------------------- --------------- <br /> r <br /> ------------------------------------------------- --=-------------------------------------------------- ---------------------------------------------------------------------- ---------------------- <br /> (Drow 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.Joaqui.n.LocaJ_ Health District. Home owner or licen- <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 laws of California." <br /> Signed --------------------------------- - Owner I <br /> r BY --- g ��4 ----------------------------------------------------- Title ----- awilcex-------------------- <br /> ------------------------------ <br /> :[ other than owner) <br /> FOR .DEPAR USE ONLY <br /> 4 dd APPLICATION ACCEPTED BY ----------------------------------------- DATE -- <br /> BUILDING PERMIT ISSUED ------------------ -------------------------------------------------- <br /> -------------------------------------DATE <br /> ADDITIONALCOMMENTS ------------ ------- --- ---- - -------------------------------------------------------------- ----------------- -------------------------------------------- <br /> ------------------------------------------- ---------- -------------------------------------------- --------------------------------------- --------------------------------- -------- <br /> -- ------------------------------------------------------- �------b <br /> ----------------------------------------------------------------- ------------------------------- - <br /> �----- - -- - - � - *� - <br /> --------------- - ------ <br /> ----- c ------- <br /> i-Final Inspection by f-' = --_ < = _ .___-------------------- - ----------------------------------------Date -f----------------------- - <br /> i, SAN AOAQUIN LOCAL HEALTH DISTRICT <br />