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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. � .710. <br /> (Complete in Triplicate) <br /> _. This Permit Expires 1 Year From Date Issued Date Issued <br /> /J��_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to onstiuct 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/LO7114, 14- <br /> ION l�I/L�/ � �j� � y l�-_ ff qP1! / /'-,V/o//CENSUS TRACT . _ _ -/ . . .. <br /> Owner's Name 71 o 4, if , 6"r, f-- _ .. Phone(l O.�y 'f 0 <br /> .� Address /P ' G h 6rX5\ _ OM19� F'1y1Z _. ..- <br /> i <br /> Contractor's Name Q C✓ k1 P __ _ _- ...License # Phone .. - .. .. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer Court <br /> Motel ❑ Other <br /> Number of living units: I Number of bedrooms -?_Garbage Grinder Lot Size ,f'�U�Y..-e -..- <br /> Water Supply: Public System and name _ _.__ _ _ _.__- _._. -. _.....- Private,o�_� <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ 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 tank or seepa a pit permitted if public sewer is available within 200 feet,) / <br /> PACKAGE TREATMENT ( I SEPTIC TANK Size . ../�. Liquid Depth - i _........_ <br /> Capacity/�� TypeAyP-(oc�erial (L,0 No. Compartments .. ..._2_.�....... 1 <br /> Distance to nearest: Well5­0 ____._ .Foundation /0 Prop. Line /O_r <br /> LEACHING LINE k1'D' Box Type Filter Materiof Lines Length of each line �6 r Total Length ?7p_'._.__.... jn <br /> / , „ <br /> a b,�(.��_.2_Depth Filter Material / - -.._._. .._.._....-..._.. <br /> Distance to nearest: Well 5-0 _. Foundation / ! Property Line _. C <br /> SEEPAGE PIT [ J Depth Diameter ..... Number Rock Filled Yes 0 No I] l <br /> Water Table Depth _ _._.__- ___Rock Size <br /> Distance to nearest: Well __. -...-._ ----Foundation - - Prop. Line ........ S <br /> REPAIR/ADDITION(Prev. Sanitation Permit# __ .. Date - _ __---.._ ..... <br /> Septic Tank (Specify Requirements) --.----- <br /> Disposal Field (Specify Requirements) -- -- ----- -.. --- ---- ----- - -- --- <br /> (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. 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 s 'ect to Workman's mpensation law of California." <br /> Signed - - _._.. _.....-_.. .... Owner <br /> By Tifle <br /> (if other than owner) <br /> R DEPA MENT USE ONLY <br /> _ APPLICATION ACCEPTED BY eer��� <br /> O7� 0 r f DATE <br /> BUILDING PERMIT ISSUED DATE .. <br /> ADDITIONAL COMMENTS <br /> Final lnspectionby: -._ �.v_. .N } 1,. - _Date ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />