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i r. <br />� FOR OFFICE USE: <br /> -` <br /> APPLICATION FOR SAPIITATION PERMIT � � .....� <br /> .- Permit No. <br /> ... ... ........ ....... � <br /> (Complete in TrlplicatO - <br /> ...... ................... _- This Permit Expires 1 Year Free"Date Issued <br /> Date issued F,,�,!{;.70 <br /> Application is hrreby made to the San Joaquin Local Health District fcr a permit to construct and install tfie work herein <br /> V.% described.Thk application is made in compiicnce with County Ordinance No. 5d9 and existing Rules and Regulationsr <br /> E "` JOB ADDRESS/LOCATION a 3J­.0 ?'; j,a� 21..o ?-A_ CENSUS TRACT <br /> ' Owner's Name fj r'_ ........Phone......... <br /> ---- .--•-----. .... ..... <br /> .pp <br /> Address <br /> Contractor's Nome City -- �•� <br /> .t,c-awl f C... r !W <br /> .... .... z.�.e....._..Licensa# (Af............... Phone .................. . •. <br /> Installation will serve: Residence[1 Apartmer.r House❑Commercial❑Trailer Court ❑ <br /> o <br /> Number of living units:- ..-.�... . Number of bedrooms ....►-_...Garbage Grinder ... ........ Lot Size --��_... <br /> Water Supply: Public System and name .Private[ t <br /> i' <br /> C.tiorocter of soil to a depth of 3 feet: Sand - F <br /> ;� p ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [� Clay loam❑ <br /> : Hcrd an�rl Adobe❑ Fill Aateriol ...... if Yes,type.....-..-•----•-••--�-•-- ' <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, otc. must be placed on reverse side.) <br /> NEW INSTALLATION: ;No septic rank or seepage pit permitted if public sewer is available within 200 loot,( <br /> y. PACKAGE TREATMENT [ ] SEPTIC TANK[ J Size...................................... liquid Depth .....-- G� <br /> ......_ Material.. ........ No. Compartments <br /> Capacity . . ... .. ....... Type ......-•-•--- ---.....-.. ............ � <br /> + Distance to nearest: Well ....................................Foundation Prop.Line �1 <br /> LEACHING LINE [ J No. of Lines . ............. L_ngth of each line .. ........................ Total Length ........ �. ..._. <br /> D' Sox .._ Type Filter Material ....................Depth Filter Material ............................. <br /> Distancc to nearest: Well ........... ....... Foundation ........................ Property line ........... ....... <br /> Y SEEPAGE PIT [ I Depth Diameter ................ Numbe- ­1 Rock Filled Yes ❑ No (3 <br /> Water Table Depth . ._.... <br /> r> Rock Size <br /> Distance to nearest: Well ......................................Foundation .................... Prop. Line .........__...... _-. <br /> u <br /> REPAIR/ADDITION Mrev, Sanitation Permit tF __... ... .....__.. ................. Date ..............................._.} <br /> Septic Tank (Specify Requirementil ....... . ........'...�......................................................... <br /> _.....-........ ......... <br /> Disposal Field iSpeeify Reqvirementsl ..............d........_.. .. .r <br /> �. . . <br /> 'C..�.....flc�s:..r.>fc ..1G G.,J.....�... ..�....;. ...3n .��Y...�r. ...t `_..., .F.G -fit JC............_.... <br /> - O <br /> (Draw existing and required addition ore reverse side} . <br /> i hereby certify that I have pmpaned this application and that tate work will be done in accordance with San Joepuln _ <br /> G: County Ordinances, State Laws, one; Rules and 94rguiations of the San Joaquin Local Health Distrid.Hent*owner or liars- <br /> ;' sad oyents signatum certifies the following: . <br /> "1 certify that In the petlormence of the work for which this permit Ir Issued, l shall nie employ any persdrs in such manner <br /> es to become subject to Workman's Compensation laws of California." <br /> 9 Si nod ... ............... ..) . ....-. -..�. : . ...�> /........................_Owner <br /> °Y tG '.o.C�. 3illEcC-7f - GSL...... .......................... <br /> (if other thaw owner) <br /> FOR DEPARTMEW USE ONLY <br /> _APPLICATION ACCEPTED BY . .:�G •-c•�r . ............ .. _.._.._ ...-.-...........- DATE.0"I ... <br /> r1LJILDING PERMIT .! SUED- . ................ .... . . .... ... .....................DATf .............................. <br /> ,ADDITIONAL COMMENTS . <br /> .... . .. .. . . . . ........ .................. _..... ....-........... <br /> y--------- ......... ...... <br /> - .. - .......... . <br /> ti Ilnai IAS an by: / Y+� - - ___ <br /> c—,-. .L�_�.: ................ .Date �y:_.... ;. <br /> SAN JOAGUIN LOCAL HEALTH DISTRICT <br /> E-!•I. 9 1.'68 Ray.SM 5 <br />