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+ 4 FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT e <br /> (Complete in Triplicate) < Permit No. ..................... <br /> _.. ( This Permit Expires I Year From Dato Issued Date Issued <br /> F <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 ......... Jt7 E- <br /> �,..,%>.......... . . .. ......v�1tU......................_....._.....CENSUS TRACT ... ............ <br /> Owner's Name <br /> + .. ! �T ............. .. - .....Y. . hone ~.. <br /> ....... <br /> Address _..... . ........:City.. S C LQ ................- _.......... ......... <br /> Contractor's Name ......A4,...rU.,�44A---. .. ------ - <br /> ............ !_License C�,5���.. Phone y ---- <br /> Installation will serve: Residence®Apartment House f] Commercial []Trailer Court ❑ <br /> e 5 -- � <br /> Motel E]Other _.......... <br /> . - ------- ------------- <br /> I <br /> Number of living units:....'...... Number of bedrooms ...�15....Garbage Grinder .-.......... Lot Size ./. ...........-t <br /> Water Supply: Public System and name ........................... _................ .........Privatef$f <br /> Character of soil to a depth of 3 feet Sand Ig Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loom ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ........_.. If yes, type....:...... ................ <br /> (Plot plan, LLI�TI showing size of lot, locction of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INST t REATON: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> NEW <br /> MENT [ ] SEPTIC TANK I 1 Size...s2,.K..9�.X,:J............_.-. Liquid Depth .J'T..Y...�.........-.� <br /> ' G ' Capacity Typed9X . Material_ ............._.... No. Compartments ...9............. <br /> Distance tol .0 <br /> nearest: Well .. J.......................Foundation/ ...........: .. <br /> .... Prop. Line .._..;_-.......... . <br /> LEACHING'LIN�E ,. ( ] No. of Lines ... .... ..... Length of each line.... 6_............... Total Length °-..-......-...� <br /> 'D' Box ...- Type Filter Material Xp -Depth Filter Material .� 4 <br /> Distance tonearest: Well -.,jlft!............. Foundation _6................. Property Line ...........-......--...-. <br /> SEEPAGE PIT',.O DepthLs` Number ...;� ._............ ... Rock Filled Yes C3 No O` <br /> Water T6b1e D'epih....�`.4......... ...........................Rock Size ................................ <br /> ( f Distance to nearest: Well .......`___..................-.......Foundation ......._........... Prop. Line ...................... <br /> REPAIR/AD (Prev. Sanitation Permit # ..................w__..........\... .... Date ............... .................. <br /> Septic Tnnk.`(Sp'ecify Requirements) , , •, -- ------\ <br /> Disposal+ Field((SpreTcify-,Requirements) ._.......---...... -.............. .......... _..........-.....-r .......:_... <br /> r r .,. ......... <br /> .......... .'..................... ............ <br /> I r--s-- 7 <br /> G ;:--^- .............— <br /> (Draw existing and required addition on reverse side) <br /> I hereby c rtify thatM-Rove prepared this application and that the work will be done in accordance with San Joaquin <br /> County Or finances, Stote Dews,and'Rules and'Regulations of the San Joaquin Local Health District. Name 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, 1 shall not employ any parson in such manner <br /> as to become $ub, Mo�ygFkma ' Co pensatiof Ca <br /> n laws olifornia." <br /> Signed . � ,....L ...................................... Owner <br /> By ...: ._. ! ! y Title _....... . ............... <br /> (If other tK6ii owner}` '" .._ e, <br /> m_ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....... _..__.....-'-.................._....... .............-.-...... DATE .....h-/_9:2 ..........PERMIT-ISSUED ..- :.......... <br /> ........._..................................................-.-........._.......::.- DATE-. - :..'............... <br /> ADDITIONALCOMMENTS ............................................................... ..................__ ........ ,....,-�...................... ......... .......... <br /> ............................. ........-........._ .............................. <br /> - .........................I .......... ................... <br /> ............................_......._.....--.. ... .. <br /> -- <br /> Final Inspection by: ............. . . ..... ...... ... +c�...:-............................................_.............................Date ...��:/ ..... ......... <br /> SAP! JOAQUIN LOr_AL HEALTH DISTRICT <br />