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FOR OFFICE USE: <br /> �'LICATION FOR SANITATION PERMr./ <br /> ---------------------- - <br /> (Complete in Triplicate) Permit No. .....:................ <br /> This Permit Expires 1 Year From Date Issued Date Issued ..9��2/�� <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 ADDRESSAOCATIIOON �-3' Q <br /> �/_ -__1� _._. __. p_—4I.-:�_: -__--_-_----p j.�l) v{_-CENSUS TRACT --_S �� _ <br /> - _. _ <br /> Owner's Name -- P.o(!,,� D Phone . <br /> .� Address ------ � _13---------�--------------f=> - Y.` ---••City ---- ---------------------------------------------------- <br /> Contractor's Name....0. AJZ_4 ------ P ---------------------------License # ---.-----:------------__ Phone ------------•------•---------- <br /> Installation will serve: Residence artment House❑ Commercial❑Trailer Court ) <br /> / Motel ❑Other----r------•-•---•------•----------------- <br /> Number of living units:......(_-- Number of bedrooms __�-barba a Grinder --- �L�r` _ <br /> g �._ Lot Size -- -------- - -•---•-- •--- <br /> Water Supply: Public System and name ------------- € - ------------Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑? Clay ❑ Peat Q., Sandy Loam fl Clay toam <br /> Hardpan❑ Adobe-j] 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 pernrjtted-if public sewer is available within 200 feet,) (N <br /> PACKAGE TREATMENT [ ] SEPTICTANKI ] -Size:._------_-----------_---_------------__ liquid Depth ..__- __-..__ . . <br /> Capacity -------------------- Type ------- Material=_f ------------------ No. Compartments ------ ----- <br /> Distance to nearest: Well _-_____._s--------.,,_,_______;__-Foundafion -.______- --..__ Prop. Line - -- ___._-____.-- _ <br /> LEACHING LINE [ j No. of Lines ________________________ Len tl�'.of each line__.___-_------_------- tal Length <br /> D' Box ------------ Type Filter.Mate ial <br /> YP ---------------------Depth Filter Mater al - ------------------ --- <br /> Distance to nearest:.Well [__ _____ ___________ Foundation ___-..._.._._.__ __ Property Line _._..._.__.___-._.._.._ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter _______________ Number ..__.'_. _ ------------ Rock Filled Yes ❑ No ❑ <br /> Water Table Depth .............. <br /> ------------------------------=--Rock Size ------ -- ------------- <br /> Distance <br /> -•--------Distance to nearest: Well ..... -• ------------------------Foundation --- ----- ------- Prop. Line ------------------- ._ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _________ _______ _ ___________________- - Date --------- _ ----------- __--______) <br /> SepticTank (Specify Requirements) ----•---------, '- --------- ------------------------ -------------- -- ----------------------­---------i­--------------------I <br /> Disposal <br /> ------------- -- - <br /> Disposal Field (Specify Requirements) _____/g� :_"_.'n6ffT.. I.N[ ..'_bos=_i aX-----__-_-7V--------BF-__•.2 __--_ <br /> LJq4)-t - /_J_N r -PAft1__` EP <br /> Ti Er1�--- •--- -- X ,xR` A.G <br /> > (7' <br /> •' r. <br /> (Draw existing!and requirecl,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' n of th San Jgaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: ==`lt. . <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 ....... <br /> (If other than owner) <br /> - - - FOR DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY ___ _ _ -- t '`-' ._ y <br /> - ------•-...---------------- -------- -------- = DATE '" �/ <br /> BUILDING -PERMIT ISSUED----------------------- ---•-------- ---- ------------------------- -------------------------------------- --------------------------------- <br /> -------- <br /> ------•-•---------------- --........_ <br /> ADDITIONAL COMMENTS ----- --------- -- -------------------------e14,-: <br /> -••-•--------------------------•-•------. ------- - <br /> -- <br /> ----------------------------------------- ----------- ------- ----- ---- ---- ---------- <br /> - ------------------- - - --- ----- -- -- --------------------------------- <br /> - --- - - -Final n -------- ------ ---- -- - - -------Date ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />