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-- - APPLICATION FOR SANITATION PERMIT..,.....,.....:,........ ,....::.................: tCompleto In Triplicate), Permit NO. ...� .`7 S1� <br /> .............•....... ... ................. .. .`.. This Permit Expires 1 Year from D Date Issued ... . .�l�S <br /> aM Issued � .. <br /> Application is hereby made to the'San Joaquin local Health District for a permit to constneq and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulat1w4h <br /> JOB ADDRESS/LOCATION .4010 .E Fremont <br /> Owner's Na Dora E E. S c h ae ._e r................. .......................... ............................CpVSlJS TRACT .............. ....,• . <br /> Address ..........m!�U10....E�...Fremont............................... .. . ............. ... ............. .................Phone ....................:............... <br /> City :S. o>i3�t4 ,....... <br /> Contractor's Name ......ROTO ROOTER SEWER SER •. License L�4(2715 ... ]�$5-2616 ..». <br /> Installation will ascus: ........................................... done ... ............ _ ... <br /> 1r Residence(3 Apartment House Commercial Mraller Court E3 <br /> tMotel ❑Other................:..:.......:.......... t <br /> Number of living unitsr..._ _ Number of bedrooms ......3. ..Ga - <br /> • rbage Grinder xis.. Lot Size ..7.. _t3.G.J;.R. <br /> Water Public S � Vater _ ..»M..:...... .�•: <br /> Supply, ystrarr� and name .........fie sl i f.... .. ...._. ..».».........: ...........................Prlvcft❑. <br /> Character of toll too depth of 3 feet Sand❑ Silt o day. ❑ Peat❑ . Sandy loom❑ Clay Loam❑ <br /> Hardpan Q Adobe Fill Waterlol..19......ff ` <br /> Yes,type............... ..........:. . . . <br /> (Plot plan, showing sure of 'lot, location of system in relation to weals, buildings, etc. must be placed on reverse 01163, <br /> NEW INSTALLATIONr No septic tank or seepage pit permittee! K public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ } SEPTIC TANK( Size.................................................. Liquid Depth �..:...............». <br /> Capacity ................ Type ..................... Material.. ............... . No. Compartnwr .:... <br /> Distance.to nearest: Well ............................ .Foundation ....... ...:.....: ..... Prop. Line'». <br /> '» <br /> LEACHING LINE 11 No. of Lines. .. . .. Length`ofeach dine. .. .J»"»....••_. <br /> Total length ....................... <br /> 'D' Box ............ Type Filter Material .:.. ...............Depth Filter AAciterial .........................:»..,,...:..... <br /> Distance to nearest: Well ........................ Foundation .. .... .. ......... Property Line ....................... <br /> 0 <br /> SEEPAGE PIT [ } -Depth .................... Diameter . Number ..........:..:..... Rack Filled Yen ❑ Mo <br /> Water Table Depth ..............................................Rode Size .................................. <br /> O� <br /> Distomas to nearest: Well ..................... .................Foundation`................ Prop, Line ....... <br /> kEPAIR/ADDITION IProv. Sanitation Permit 9Ii pate .... <br /> Septic Tank (Specify-Requirementsl ..................... adc� O :........ ........... <br /> 'ir_....... 1 .....:.: Ib.. <br /> ig�a�--,��. .�... .cls-a:...h�r. �1 •� <br /> Disposal Mold (Specify Requirements) .............. ... ........................... Y <br /> ................. .. .._......... ..........................._ ............---.... . ......................•. .. . .. .,. ...:.............. ..... ...»... <br /> ..........................................................._.....---------.._...... ..:.....:..... ..........»..... ............. <br /> (Draw existing and required addition on reverse side) <br /> l 'be-reby certify that I have prepared this application and Thal Ilse work will-be stone In accordance Muth San ,lee>t{ttM` <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Loud Meakh,District. Meme owner or Haw <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is issued, I stela) woe employ any person In sent wrepsnw <br /> as to beco e s blect to Workman's mpensation laws of California." , <br /> Signed ..... .. .... Owner <br /> By .............. . . .. title ....... <br /> other than mer) Cont�r�:�'CtS�. .."'•""". <br /> FOR DEPARTMENT USE ONLY <br /> APPLICA 10 ACCEPTED BY -C ......................•• ---......._....._...... DATE .�.11 .1 .. . ..................--........ <br /> BUILDING ERMIT ISSUED ............... ...... .. ..---.....DATE ......................:. . <br /> ADDITIONAL COMMENTS ..........I.......... <br /> ........._.I.............. s ....................................._.......... <br /> .....-. _.� .. .. ...i. ... ................................... <br /> Final Inspection by .... . <br /> Date . <br /> `. .. ...........................................Date ................ .. .... . <br /> EH 13 2L 1-6 Rev. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />