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h a�# FOR Oi F10E USF <br /> APPLICATION FOR SANITATION PERMIT , <br /> Permit No <br /> (Complete in Triplicate) <br /> Date Issued -.JC. -C. <br /> This Permit Expires 1 Year From Date Issued <br /> Apphcat:on !s hereby mo-:(, t., he <0-1 Joac.,'n Lcrol Heol•h D str rt for a perm,t to construct and instal' th,r work herein <br /> described. Th;s accGacticn isl.nc,Je in con ,.lance with County Crd nano No. 549 on•i existing Rules and Regulations: <br /> ' JOB ADDRESS.•-LOCATIGN '' `' Y ` r - r CENSUS TRACT _ _.. . . <br /> . On '_ "Ic: } Phone _..._........ - <br /> r` <br /> —� Address c 1:.r / c 1 City • ,-.C, __... . _... - . <br /> C' Li _.......- <br /> Contractor . Name � r - , .j cense y! ��/ s�- Phone� <br /> Installation will serve: pesirlence ?Apartme,t Hous:i I Commercial :Trailer Ccurt <br /> a. <br /> :to;el ^Other <br /> Numher of living urnts Number of bedrooms Gorbegr Grinder Lot Size ' <br /> f 4 Wr'cr Supply: Public System and name - <br /> __ ._ ... Private r_-r <br /> ' Character of ,cii to a death of 3 feet: Sand Silt[ Clay Peat- Sandy Loorn i j Clay Loam ❑ <br /> Hardocn 7"1' a„',e ' Flit Material If yes, type <br /> (Plo' plan, showing sil(! of lit Incotion of -.)-stem in relation to wells. Luildings, etc. m,!st be placed on reverse side.) <br /> NEW INSTALLATION: No septic tanb or seennge pit permuted if public sewer is availob!a within?00 feet,) <br /> PACKAGE TREATMENT ; ' SEPTIC TANK, ( T Size Liquid Depth <br /> d Capacity Type V:,terini No. Compartments . . ... <br /> Y <br /> - Disronce is nearest Well Foundation Prop. line _.. .... ...... . <br /> LEACHING LINE f 1 No. of Unes Length of each line Total Length <br /> D' Box Type Filter Material Depth Filter Mcterial <br /> :.. - <br /> Distance to neores;: Well Foun—'7liOn Propery Line _ <br /> SEEPAGE PIT D,pfh Gi�imeter Nurr,be- Rack Filed Yes ❑ No ❑ <br /> Viater Table Depth ..Rock- Size <br /> Drs•ai.ce tc nearzst: Wei Foundation Prop. Line _ _....... ... .. <br /> ;} pate _ ) <br /> REPAIR/ADDITION'Prev. Soni;at on Permit-# <br /> Septic Teni (Specify Requirerrnen;s! <br /> D sposol F eid :Specify Pequirementsi 30 <br /> ` Draw cr.i;ting <br /> and re'fwred add'tion on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance •aith San Joc.quin <br /> County Ordinances, State Lcws, and Rules and Regulatirns of the San Joaquin Local Health District. Horne owner o: 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 o.ry pe-son in sc ch manner <br /> t� <br /> t <br /> as to become subject to Workman's Compensation laws of California." <br /> -. S;3r"d Dwner <br /> cher then Owner! <br /> r0_ R DEPARTMENT USE ONLY <br /> r APPLICATIC j ACCEPTED BY f'ATE <br /> Dc <br /> LOCAL cA I' D!STR!CT <br /> ..� n <br /> F.- <br />