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FSR OF_FIC.E.USE: <br /> '*vWPLICATION FOR SANITATION PERh4T <br /> . .. . . ... Permit No. .7....... ... <br /> (Complete in Triplicate) ..... <br /> . ..__....._................ This Permit Expires 1 Year From Date Issued Date Issued ...7............. <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 <br /> compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..-..� 1 a !�....... -_."'*' ... ..... .. - .... . . <br /> CENSUS TRACT .-•----....L-.l... ....... <br /> Owner's Name ...A/"/.iG;2 ........,...A6AV4e.f............_.......... ........1 -•`--................Phone <br /> Address .......f?f-p.... �J -..�-6 3� .......... <br /> ..................... <br /> Contractor's Name ..Ql/i!✓C=rQ.-"....... .........................................License # 30734 Phone .............................. <br /> Installation will serve: Residence RApartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑ Other .... ----- . . ........................ ��Z✓ G <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 Loam Sri Clay.Loam ❑ <br /> Hardpan ❑ Adobe E] 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 seepage pit permitted if public sewer is a)9ailable within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK)K Size_...��U U.. ..--..,.�..,.p........ Liquid Depth .......................... <br /> Capacity� ? ....._. Type _Co `� ... Moterial.Yn.�V`/...'.j No. Compartments .......r. <br /> �'� .. R <br /> Distance to nearest: Well ---f�.�..... ............Foundation ....1� .. Prop. Line s�................. <br /> _P dotal Length __.�2 C) f <br /> LEACHING LINE (yQ No. of Lines .._. G�...---.... length of, each line. _. <br /> D' Box ... ...-- Type Filter Material.lL��..L pth Filler Mc erial .-..../.-.�.............J........___.. <br /> Distance to nearest:�W II Za .f_ ._ f'o�((un�jtiory...... /�_.K Property Line 5.-?G___.------- <br /> SEEPAGE PIT O Depth _ 'Diameter .... 2Num6er ..-..---.-_-..-._...... Rods Filled Yes C] No p <br /> ,761,oy S' Water Table Depth ................................................Rock Size ---................_..........P <br /> / Distance to nearest: Well ........................................Foundation .................... ProLine ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit#' .........--..................__--.--.---. Date .................................. <br /> Septic Tank (Specify Requirements) ...- .. -... __ F.... -- .. _l---••----•�--•- <br /> -...__......--•-- <br /> Disposal Field (Specify Requirement --`- -t17. ............•-----.-•-------------..-_......-----......� - - .. . XIG <br /> -------- -- ........_-----------------------------------------------............................................................................ .................................................------ --- ...----------- ----- . --------- <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 ;ybject o/�, <br /> N[or Tan's Compensation laws of California." <br /> Signed . . _� ... zl._$rLtG.ciL ........................... Owner <br /> By ........... . •. ............. - - -- .............................. Title .... -......... ................._._.....__...- .--. _.... <br /> (If other than owner) <br /> R DEPARTMEtff USE ONLY <br /> APPLICATION ACCEPTED BY ........... ..... .... ......................:..../---...----------------_---------------. DATE -----7 /--7---Z._........ <br /> BUILDING PERMIT ISSUED ..---•---••--------------•--..----------------............ ....................................--......DATE ............---...... .....---.... <br /> ADDITIONALCOMMENTS .... ........... ................ •--......................... .............................................................:.-..--•.................... <br /> ..... .._ -.... .................................... ........................ <br /> - -- -- <br /> .._...--------------•--•.......................... ......• . .............. ..... <br /> - .................. - ........................ <br /> Final Inspection by: .. ... - /��'---- -- •--- ......_...... ............ Date .. .-. 1r�0.. .._.-- <br /> SAN J014 LOCAL HEALTH DISTRICT rya, <br />