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FOR OFFICE USE: <br />�. PLICATION FOR SANITATION PER_ .r 73—/13� <br /> .: <br /> (Com late in Triplicate) - - <br /> Permit No. ..................... <br /> ............._------ ------ `� <br /> • .......-.,...... This Permit Expires I Year From Date Issued Date Issued_� .JET__.. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instoll the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> 10B ADDRESS/LOCATION - .w .(__-.- . .._ . �C`-c�z � � _ . . .... ... .. .......... ......CENSUS TRACT ........................... <br /> Owner's Name . ...L-C:....,/....�..... � ............... ..................Phone .................................... <br /> Address ..... •-.- City ...L.C.C, ..................... <br /> Contractor's Name ...... �-+.�•+..�-a-._ . - -�- �----�-----'-`,'-_�-=Z_:<tlicense # Phone .............................. <br /> Installation will serve: Residence[6/Aportment House 10 Commercial ❑Trailer Court C] <br /> Motel ❑ Other ............................................ <br /> Number of living units:........f... Number of bedrooms _-.%'3......Garbage Grinder ..........._ Lot Size .......... ....................... <br /> Water Supply: Public System and name ---------------------------------•------- --------- -------------Private �. <br /> Character of soil to a depth of 3 feet: Sand ;/Adobe <br /> ilt p Clay E] Peat EJ Sandy Loam E] Clay Loam ❑ <br /> Hardpan ❑ 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 204 feet,} �J <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ j Size---------------------------------------------_ Liquid Depth ....................------ <br /> Capacity .................... Type -------------------- Material-------------......... No. Compartments ............. <br /> Distance to nearest: Well ....................................Foundation ............. Prop. line ..___...---.......---. . <br /> LEACHING LINE [ ) No, of Lines ------ ................. Length of each line --------------------------- Total Length ............--.......----_-. <br /> 'D' Box _._._....... Type Filter Material ....................Depth Filter Material .......----------------------.__........... <br /> Distance to nearest: Well ........................ Foundation ............ <br /> ....... Property Line ........................ � <br /> t SEEPAGE PIT [ ] Depth ......... ... ...... Diameter Number ----------------,_. Rock Filled Yes ❑ No <br /> Water Table Depth ----------------------------....................Rock Size ............................ <br /> Distance to nearest: Well ........................................Foundation ------------ ------- Prop. Line ....................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ......---_.-----_-__.__-_____---_-J <br /> Septic Tank (Specify Requirements) --------------------- - ----------- ----------- ---------•- -----•._._. - ------- �. <br /> Disposal Field (Specify Requirements) � 4? .. —--_. "-( .... ........ .... .. L..-_ ._.._. N <br /> Cx ---- f ��� <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 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 ... :...... ............... .......... <br />( By . .. . .. - --•:-.....fit-.���1---�.......•... . -.-C.::�.-•- ----- ---------- ��'�..:.:....4------..<.........----- - <br /> (If of er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _,� :::____...=' - =------ -------------•-•-- ........................................ DATE :'- ------ <br /> BUILDING PERMIT ISSUED .................... ....................................................................................DATE .. .- -...... ........ <br /> ADDITIONAL COMMENTS ....---........... ................. ----............ •-._...---_---_ ------ --_--------- ----------------- _-----..-•---- <br /> ..........----.............................................................................. • ------- ---------------------------------------- ................ ........ ....... <br /> -- ..........- ...................--- ._..._ <br /> FinalInspection by-. _.,---------------------------------------------.-----------------------------------------------------­­.............Date..-_ ---- --_-------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />