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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PEPuAlT <br /> (Complete in Triplicate) Permit No. ..7�.f.� <br /> . ....... . ................................... ....... <br /> """' <br /> ... <br /> ......... - •. ....................................... This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby mode 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: (n <br /> JOB ADDRESS/LOCATION .L`7r./YL/..<_5 �..p ./YJ�Jr{FthL�:f/.w'u._.era!F2i✓l�LL? NSUS TRACT .......................... Q <br /> Owner'sName F� Cc F.V. I. /�r..f�1.....:.516 5T. 4,1- /.,V. ........:.....................Phono�l�' ��v�.�� ......... I _ <br /> Address -/O.....fti'E 4171.1. .c?1!<%1 /�1 K�/!fAS City .�lZ' i �l>//C�............................/.................... V <br /> Contractor's Name ...�1w E..S.....31/..F... .......................License #17T3. .... Phone 1j�G{7..:,�N�l(i <br /> Installation will serve: Residence ❑Apartment House❑ CommercialZTraller Court ❑ <br /> Motel ❑Other ............................................ <br /> Number of living units:.... ..... Number of bedrooms ...-:.....Garbage Grinder /�1..�.... Lot Size 7..f'/...X....T:WZ�.-..-. <br /> Water Supply: Public System and name ... . .......... ................................... ......................... . .............. .............Prlvate� <br /> Chorocter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ] 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 permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size.. <br /> J?d h�.��..J.IS.S.!................ Liquid Depth ............... <br /> Capacity . Jr'........... Type Materi4-,% e/a,&- No. Compartments <br /> Distance to nearest, Well ...,lC{ ....................Foundation ...A............... Prop. Line .-C............. <br /> LEACHING LINE No. of Lines ....f.................. Length of each llne...40-47............... Total Length ./.. ................ <br /> 'D' Box ./ALU.. Type Filter Material .,ejQ�24K....Depth Filter Material ../..j. .............................. . <br /> Distance to nearest: Well .f.LG .......... Foundation .Z!. ............. Property Line .:5................... <br /> SEEPAGE PIT (4 Depth _..R...-�...-. Diameter .: .�.. Number ......� ................ Rock Filled Yes;, No ❑� <br /> 7 . / / i. .i <br /> Water Table Depth .:Ot2..Q.....................................Rock Size`."�W-- t/.............. <br /> /� <br /> � <br /> Distance to nearest: Well ...,� $�A..? O...........Foundation . .. .............. Prop. Line . .....»........_. <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ................................. ] \ <br /> SepticTank (Specify Requirements) ...................................................................................................................................... <br /> ... <br /> Disposal Field (Specify Requirements) ..................................................................................................................................... <br /> ......................................................... .. ...................................................................................................................................... <br /> (Draw existing and required 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 Regulations of the San Joaquin local Health District. Home owner or Iicen-� <br /> sed agents signature certifies the following; <br /> "1 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 Com ensation laws of California." <br /> Signed __ ....................... Owner <br /> .. .... ....... ...................... .. /l <br /> By . ... .... . ............... . .. . . ............................. Title ._C� . ... <br /> .......... . <br /> (If oche hen own <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... ........._.L.rG..........,.r.;.. ..-L: .. x:Crf��!.......................... DATE ..-C...c... ...... <br /> „t�.. ........ <br /> BUILDING PERMIT ISSUED .......................................................Irr............. ..................................DATE ........................................... <br /> ADDITIONAL COMMENTS .................................................................._......................................................................................... <br /> ......... .. ........................................................................................................................................................................................ <br /> ............................................................: .................�.... <br /> ............................................. ..... <br /> .... ..................................... <br /> .. . ..... . . . ............. <br /> ». �......7......,1......... ....��.. <br /> Final Inspection by: ............'..... ....... . ....... ........................ <br /> .L��. ...........................Date ......;..�.,,:�.:?...................... <br /> SAN JOAC IIN L L HEALTH DISTRICT �P�r�- <br />