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Date <br />8/7h 3M <br />11-7 Final Inspection by: <br />EH 13 214 1-6f3 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br /> <br />l'OR OFFICE USE: <br /> <br /> <br />APPLICATION FOR SANITATION PERM <br />(Complete In Triplicate) <br /> <br />F .4.11pat <br />Permit No. <br />. • , <br />Date Issued <br /> <br />_ <br />This Permit Expires 1 Year From Date issued <br /> <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install <br />the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />JOB ADDRESS/LOCATION <br />Owner's Name R. .5../ .,,,,,ezi pea....,,,/ , Phone Address ,5-4.447.1 , City /VA •-7-.:77 - ,..c2. <br />Contractor's Name "4...4. .n.i.e4ra--7/E. i ticenkt # aP-'2V-7.5.fr,g, Phone .23 Installation will will serve: Residence fR1 Apartment Nausea Commercial °Trailer Court 0 <br />: Motel 0 Other <br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy LoomIr _Slay Loam 0 <br />Water Supply: Public System and name <br />Number of living units:...../ Number of bedrooms / Garbage Grinder 1 <br />1 <br />Lot Size 6--- <br />Private 121 <br />I Hardpan 0 Adobe 0 Fill Material If yes, type . <br />,,(Plot plan, showing size of lot, lc:cation 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) F PACKAGE TREATMENT j] SEPTIC TANK { ] Size...15>425.V.X.IF Liquid Depth -g <br />Capacity ./1) 2,0.0.-0 Jype 1:-...421,1_7-Material _ ,_,.....__No cprtwartments i; i ' <br />Prop. Line .,/ ........... :1 No. of Lines a Length of each fine.. 15722 Total Length ..„/v? /1 0 <br />i <br />'D' Box / Type Filter Material ./...e...)K.11,'/Depth Filter Material -,e on - '‘• I- ,._ o L..._ • i i Distance to nearest: Well ....VP Foundation 4:. 0 Property Line .7:a- - i .. <br />- v; <br />'L Water Tai3le.,.Def3th Rock Size <br />Prev._Sanitation Permit 4. Date )/ Septic Tank (Specify Requirements) N O <br />Disposal Field (Specify Requirements) <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 agent; 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 />... e„, <br />as to become subject sotef srkman• Compensation laws, of California." I ; <br />Signed <br />d"..-;., <br />Owner; _ <br />/ <br />(If other than owner) <br />FOR DEPARTMENT USE ONLY <br /> DATE . <br /> DATE <br />a <br />-1 <br />// .47 5- ‘,#1,4ti /fp CENSUS TRACT <br />c <br />_ <br />LEACHING LINE <br />SEEPAGE PIT 1 Depth Diameter -- Number <br />70 .1 Foundation /41 <br />Distance to nearest: Well <br />Rock Filled Yes 0 No ' <br />Distance to nearest: Well Foundation Prop. Line REPAIR/ADDITION ( <br />By-- <br />Title.