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FOR OFFICE USE: tyPPLiCATION FOR SANITATION MAX <br /> Permit No. . <br /> ............................... . ... (Complete In Triplicate) <br /> ......_...................... ... ....................: Date Issued <br /> - ...--.--•........ ....................... This Permlf Expires 1 Yeor From Date Issued <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 /> f� C' 7( A •-c� ,7 .......................... <br /> JOB ADDRf55/LOCAT .�.3-..-- - -S!1�.... �-Y•r'a21.�................................CENSUS TRACT <br /> Owner's Name .. Phone ................................... <br /> . <br /> •� <br /> Address - _. .... .. City 4;...... ............ <br /> •.... .................. ....._... <br /> o� yy <br /> Contractor's Name ._ -t <br /> G.a1 ..-.License ill �cy .'Lr ...- Phone .............................. <br /> X�614 .. . ....... ................. <br /> Installation will serve: Resi encs(v(!rtment HouseQ Commercial❑Trailer Court <br /> Motel ❑Other............................................ <br /> Number of living units:.......... Number of bedrooms .....- .....Garbo a Grinder ------...... Lot Size ....1-i..�P -••----•----•- <br /> Water Supply: Public System and name .................................... .._ 9 ...... ......................... . ------. ...... "..Private � �) <br /> Character of soil to a depth of 3 feet: Sand[]/Silt[I Clay ❑ Peat❑ Sandy Loam ❑ Cloy Loam C] 0 <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 see age pit permitted if public sewer is available within 200 feet,) <br /> h � <br /> PACKAGE TREATMENT ( ] SEPTIC TANK[I Size.9146Y&# K.5� .... Liquid Depth ..19. <br /> ... <br /> Capacty �.(ctA.G � <br /> ..... � faa � < ° . Z oY _ <br /> ....•...... <br /> r <br /> Distance to nearest: Well .-.--------- ............F'oLundation ......1.c'/ ... Prop. Line ...:'. ...........I <br /> LEACHING LINE [6� No. of Lines _.....41._-......... Length of each Ilne. s a�.�T _ ,... Total Length <br /> 'D' Box .../........ Type Filter Material ....5� .......Depth Filter Material ...../.%... ...............•...........Distance to nearest: Well .......4F� . . Foundation ....!c ... Property Line .. ----_--it —/ <br /> SEEPAGE PIT (' ] Depth _..�.`1�.. Diameter ...:�.�....- Number ..-......_�..,....r_. Rock filled Yes (;� No <br /> Water Table Depth -----------------------Rock Size -.1..1a.:.x--3--.-...... ��¢¢- <br /> Distance to nearest: Well .......1X2.6-t - ---------------Foundation ...LO--�---- Prop. Line ......�..,L..f..-... <br /> REPAIR/ADDITION(Prev. Sanitation Permit iP .................. ......................... Date .--.--....---_...........•.•.....I 79999 <br /> SepticTank (Specify Requirements) ...................•.............._........................................-....--.........................._.......................... <br /> Disposal Field (Specify Requirements) ----------------•------......--........_•-•---------...................................... . -- -- <br /> .......-----•--•.... .......................... ........ ... ..- ......... ---- --- ............ <br /> .... .. . ...... ................................ ................ ...........................-. _....---•...........-.. _ -._-... .. <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with Son 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 /> "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 Compensation laws of California." <br /> Signed ------------------------- --- ------ - Owner <br /> . . / .-. . - -- .. . . title - �L <br /> By (If other than owner) <br /> pp FOR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY l-'-- . .-'.._- ------- - -------- --------- <br /> - ---------------- .......... DATE $ 3/ ..Z..... <br /> BUILDING PERMIT ISSUED -------- - - - - ... --- -- - - ....1-1---I--- --- --------------DATE - - -------------------------- <br /> ADDITIONAL COMMENTS ...........- -- - --------------------- ---_--_--_-------- .. ........ .. .. ­--------------------...._ - _ ...._ . ........ <br /> --- . ..... �/%. . . .... . ... . <br /> Final Inspection by: . ---- �,. . - _. _. .Date . . .- . _.. ... <br /> Eli 13 211 1-68 Rev. yM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />