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`s M rc;, OFFICE USE <br /> t f� t� j}f04_� ,�• APPLICATION FOR SANITATION rtROIT , <br /> f � �� ` rPfmit t•10 -. <br /> (Complete in Triplicate) <br /> Date Issued . .. ,. <br /> s . This Permit Expires 1 Yenr From Dote Issued <br /> t <br />�s�.,... Applicnrion is hereby rr+ode to the Son Joaquin iota! Health District 'or o p,?rma to construct and install the work h prei <br /> descr sed. This application is mode in compliance with County Ordin ce No. 3 0 and e�lsting Rules and ReQulytlon <br /> JOB ADDRESSAOC fAfTTI�ION �' <� �M7G�+^t /l P.c4 r CENSUS TRACT . <br /> Ac -! a phone <br /> Owner's Name 1 y/ <br />}' Address lioi�� .�^ [k"} City :?�cc ILTc`x� <br /> f/.(J <br /> Contractor's Nom- Cf44et>`GI r,vn�.. .. .... License # Phcme -� '••• <br /> a Installation will -erve: 0,rs ywff Apartment House Commercial j]TrailerCou:t r7 <br /> Motel ❑Other _ .... _ <br /> Number of living units: . Number of bedrooms .JOV./Garbage Crinder . Lot SizecJ ...�GC�•. ...•.• <br /> Wo'ar Supply: Public System and name . J <br /> �I"..LC1,r0&4.... _ . ... .. ... .. .. _ .. ._. .... . .....Private ❑ <br /> Ctiaracter of soil to a depth of 3 feet: Sand❑ gilt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ <br /> Hardpan j] Adobe JR Fill Material If yes, e <br /> typ .. . .. <br /> (Plot plan. showing size of lot, locarion of system In relation to wells, buildings, etc. must be paced on reverse ldol 6 <br /> NEW INSTALLATION: (No septic tonk or seepage pit permitted If public sewer is available within 240 feet,! <br /> _ J � <br /> PACK4GE TREATMENT ( ] SEPTIC TANK[ ] Size ....... 7Jl. . _ liquid Depth ... ....... ........ <br /> Capacity . Type _. . .. Material ..... . No. Compartments _. ...... ......... <br /> rte•, <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 J ........ <br /> Distance to nearest: Well Foundation Prf�ef� line ❑ ....... ]� <br /> SEEPAGE PIT_ ( j Depth Diameter Number Rock Filled Yes o Q V <br /> Water Table Depth ..... ....... ........ . .................. ..Rock Size ........ <br /> Distance to nearest: Well ............ ..........................Foundation ............ .... Prop. line ...................... <br /> REPAICADDITION(Prev. Sanitation Permit# .... ,a ... <br /> 7De <br /> � . <br /> so-;,tic Tank (Specify Requirements) n <br /> GL..... .C.+ .. ..,r��`�! ...... . <br /> ` Dispos iI Field (Speciy Requirements) �L .•... <br /> 4 (Draw existing and required addition on reverse side) <br /> I hereby cer1:!y fiat 1 have preanr*d this application and that the work Will be done In accordance with San Jboquln <br /> County Ordinances, State laws, and Rules and Regulations of the Son Joaquin local Health District. Home owner no Ilcen- <br />,.o sed ogentc signott•re certifies the following: <br /> w'"•`, '9 certify that In the performance o! the work for which this permit is Issued, I shall not employ any person in such tbsanner <br /> as to become subject to Workmen's Compensation laws of California." <br /> Sigoed Owner <br /> By -��.G/ +�� `f..t .i�c title �J/i�t��Y'JC% <br /> (If other than owner <br /> FOR DEPARTMENT USE ONLY <br />~ APPLICATION ACCEPTED BY DATE <br /> BUILDING PERMIT ISSUED /.' i DATE <br /> r ADDITIONA.h_COMMKNTS '7 <br /> oast <br /> Final Inspection by: _ G~ <br /> Ell 1.3 211 l-08 114. X." SAN )hAr)UIN LOCAL HEALTH DISTRICT 8/7h 3MI <br /> s <br />