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FOR OFFICE USE: <br /> APPLICATIONtiFOR SANITATION PERMIT <br /> ------ - - ...:. ---------- .......... Permit r•- - --- - �(ComplWein Triplicaro} Permit Nacp/_r--------------- <br /> _ So`I <br /> -------•-- <br /> Date Issued --..----. <br /> k. d= � Gas/ 6 <br /> r� t <br /> - .-. <br /> 1 ,-___--•-•-••---------.7--^ _d � : - ] This Permit Expires 1 Your From Dais 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 /> ADDRESS/LOC I N __ r . . .-_.--------------------- <br /> JOB CENSUS TRACT .------_.-.-..-.•...__• <br /> .` <br /> Owner's Name /TJ - . - -''- - Phon .... <br /> Address . -r-O_,-- -- j ----------------------------- - City ,f�.i 4----- <br /> --------- ....._..•...._ <br /> Contractor's Name ------..��.-d.2`�7.r__/�uJ-_---- ......1-. S.�-_:..:.....Licen e# _,�yX%�Phone _- <br /> Installation will serve: Residence❑Apartment House❑ Commerciall[gTrdit-et Court' C] <br /> Motel ❑Other--- ------ <br /> -------- <br /> Number of living units:. -- ..... Number of bedrooms ._ __. .Garbo a Grinder --_10. Lot Size <br /> ------------- <br /> iWater Supply: Public System and name .......... - --------- ..........- - .....•... -•---.-• ..----------Private w <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ 'Peat❑ Sandy Loam ❑ Clay Loam <br /> t <br /> 1 Hardpan ❑ Adobe Fill Material _... ------ If yes,type -----------------_------__ <br /> I <br /> i (Plot plan, showing size of lot, location of system in relation to wAlls, buildings, etc. must be placed on reverse side.) <br /> o. <br /> t NEW INSTALLATION: (Nseptic tank or seepage pit permitted if public sewkr is available within 200 feet,) <br /> { Capacity ------- Type .- ed-: Liquid Depth 7/ <br /> PACKAGE TREATMENT SEPTIC YANK ze..---.. d ''.._ rryy <br /> aterial- yjRc.s r �iJo. Compartments -.-.-Lr..•.._ <br /> Distance to nearest: Well ----..-.!0--------------------Foundation -.�Q........... Prop. Line .. - ....._. <br /> [ t 10. /----__ Length of each line --�..._.._-- Total Length .. ��..--..__. <br /> ` LEACHING LINE � No. of Lines -.... aa <br /> D' Box . > _ Type Filter Material 1._�/ .-..,Depth Filter Material --_-. Q... ..................__ <br /> X6_ <br /> d- <br /> Distanc .46 nearest: Well -----�5v---..___.. Foundation ....... Property Line .- �_.-.. .-. <br /> SEEPAGE PIT [ Depth _...tri .-- DiametersO-..-- Number ....../...:........ .. Rock Filled Yes Ej-�IJ <br /> J <br /> Water Table Depth ------,g-d------- ----------------------Rock Size ... lZ----- --- <br /> Distance to nearest: Well ....P.d.........................Foundation ..r��..�_.-- Prop. Lina -. ........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- -------------.--:--- Date ............................... <br /> ) <br /> SepticTank (Specify Requirements) ................................................. --------------------------•_-------------------- ------------........-.... <br /> Disposal Field (Specify Requirements) ...........T----------------- ....... ...........................................-............-................................. <br /> - .- .. ._._... - - - - ------------- --------------------- <br /> (Drawexisting and required addition on reverse side) <br /> 1 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 subject to Workman's Compensation laws of California." <br /> Signed .....-------------------------------------'---.--.-...----'-'---'---- -- .... Owner <br /> By ................................... -� ............ Title _... 1!/ s- ........-----........................ <br /> (if other than owner <br /> t FOR .DEPARTMENT USE ONLY gg <br /> APPLICATION ACCEPTED BY _T ---- -lo. ....................................... DATE ... - Z <br /> BUILDING PERMIT ISSUED ............ ..... ............ ... ............. ......•-- ------.........-------`--------------DATE ------------............................... <br /> ADDITIONAL COMMENTS ----- �` _... - ---------------•--------------7------ ------ .........•----------------------------'------------------------- <br /> t <br /> --------------------.... <br /> ... - -- t <br /> --• --•-- ---_-----_----------------- ......... .Rate FinaInspectionb ' ----- <br /> JOAQUIN off-., -- ----/----- <br /> LOCAL HEALTH DISTRICT <br />