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FOR OFFICE USE: <br /> vAPPLICATION FOR SANITATION PERMIT(Comple�e in Triplicate) <br /> ..._.. . t 'kA�.r......................... .. Permit No. ..1.3... ..,...7-d--V--- <br /> .... This Permit Expires 1 Year From Date Issued Date Issued .f-z.V-.. 1 <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 /> JOB ADDRESS/LOCATION _'. 1111-Wf-,f�fl�!....:.1 0..._. .....................................CENSUS TRACT , .................... <br /> S060'30 <br /> v 'A/... ...... <br /> Owner's Name ....... z../)......2:? .- .....k't •lIJP.E..Y.v.............................Phone ................................... <br /> Address ....................._...._,_.t............_ .............. ... ....................................I City ......................................_......:.... ......._.......... <br /> Contractor's Name .j .f�ivT..4.V o ......�.sO.4Y......._..................Llcense #/. `s" 6.:.. Phone . ..^..�V� <br /> A <br /> Installation will serve: Residence Q Apartment House C] Commercial(aTrailer Court 0 <br /> Motel ❑Other ......v:a:..c...............•---•---- <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)gj .Silt❑ Gay ❑ Peat Q Sandy Loam ❑ Clay.Loam ❑ V <br /> Hardpan❑ Adobe❑ Fill Mcterial _... ....... If yes,type ................::r:........ O <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 ( I SEPTICTANK{ ) Size..3_.a X_9FY..g.................. Liquid Depth .... ................ _ <br /> Capacity ._t.X00,__..- .... No. Compartments ...71... :........ <br /> � j <br /> Distance to nearest: Well ..................... ...........Foundation ../99............. Prop. Line �0........... <br /> LEACHING LINE [ ] No. of Lines ........al............ Length of each li/n/e....... Total Length ..J.KV............... <br /> VBox --- ...... ................. <br /> Distance to nearest: Well ........................ Foundation' ........................ .Property Line ........-.......... <br /> SEEPAGE PIT ..... <br /> �T <br /> [ ; Depth .................... Diameter -..-...-.-...-.. Number ....._.._..................- Rock Filled Yea Q No (' <br /> t Water Table Depth ................................................Rock Size .......................... <br /> Distance to nearest: Well........................................Foundation ... ... Prop. Line ..................._. <br /> M <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ..................._.......-............--- Date .................................. <br /> Septic Tank (Specify Requirements) ................... ------. ................................. . ............ ..._......................-- -• <br /> Disposal.Field (Specify Requirements) ................................. <br /> ....... - .....................• .........................-............................................................ - -...............................................-................... <br /> ..................................................................... ........................----- -------------..:. - <br /> (Draw existing 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 iwthe performance of the work for which this permit Is Issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ....... !."IeF TA _O. ....... :--'Si?A...............------.... Owner r <br /> By .......... f . ......... ... ...................... .. Title ...............................- _,_..__.... ........... <br /> (If other <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY '.. . .. ..... .....:....... ................ ..................:........ DATE .......��.- ..? .......... I <br /> BUILDING PERMIT ISSUED . :...............---...-._.._..........=..........:........:..DATE ........................................... ' <br /> ...... <br /> ADDITIONAL COMMENTS .................... ......... . ..... . .. . ................................... .............,.................. ...... <br /> -........................... I 5...------................--..-...... ..........-----..I....... ,--• .......... ... ..:................----.. ................ <br /> ..... . . <br /> - - ...............:.. ...............I—------ <br /> Final Inspection-by: ..........Date ............i....-���............. ...... I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT �y <br /> E. H.13 241-'68 Rev. 5M 7/723M 0V , <br />