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FOR OFFICE USE, _. . <br /> . {Com feta i SANITATION PERMIT <br /> P <br />.........................-...:...._._.......-.--• - - l'PLtCATIC+N FOR S <br />......................................................... <br /> p Triplicate) <br /> Pe No. ...ry............... <br /> _._...._......_............. ..................._... This Permit Expires 1 Year From Date Issuer[ <br /> 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. V490d existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ...... d�y��-------------------_-.:w14:��aC1/1��.... `-.....CENSUS TRACT ......_.. ...... <br /> Owner's Name�.j_..--- --_z_........... C. �G �1................................. _ .Phone ..._......._........-----------• <br /> Address ...... / ..._... ,/ / i�1 .. City ,.`(Jr4. .:. ...............`._._.._._._..--•-•-------........... <br /> A <br /> Contractor's Name <br /> , ...................... ---•- ......License # 5. Phone .. <br /> Installation will serve: Residence, Apartment House❑ Commercial ❑Trailer Court C1 <br /> Motel [:]Other -------------------------------------...__. / G <br /> Number of living units:...I------- <br /> Number of bedrooms ---- ...Garbage Grinder ............. Lot Size -..,S.-3-..---- .................. <br /> Water Supply: Public System and name .....................------------------------ ........... ........-...............................I——....Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe V 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 seepa pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size... `u. .}c.f a._. liquid Depth ....6. . ............:. <br /> I'r Capacity v -_-.- Type ).906E4A,o Material.............. ....... No. Compartments ....ZZ <br /> stance to nearest: Well . 9A. ................_______Foundation .`_....,.-.......... Prop. Line -•.--.-_-_ - <br /> LEACHING LINE No, of Lines length of each line Total Length .. U_........-_. <br /> V Box J.. Type Filter Material -f��.�_Depth Filter Material .....-.�1......................... a <br /> Distance to nearest: Well _........................ Foundation ................... Property Line <br /> SEEPAGE PIT [ } Depth Diameter ................ Number .........................._. Rock Filled Yes ❑ No Q <br /> J Water Table Depth -----------------------Rock Size _--------.---.--_•--_--------:-. <br /> Distance to nearest: Well ........................•---............Foundationi '.-.._... Prop. .Line -.-..........--------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .......•---- •--------- <br /> Septic Tank!(Specify Requirements) ........................ ............................ ............. .................. <br /> Disposal Field (Specify Requirements) ---------- •------_: ....-'............... .................. . ...•-----. <br /> :.. ................... .................. ------------- -------- ........_.........- .............._... .......... <br /> .................................... . ........... ._ ,..:,---:................... _ .._.__.. ._._..._._ .......-------- ............,.......... <br /> (Draw existing and required addition on Feverse 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 Rulei and Regulations of the Sarn Joaquin Local health District, home owner or liven. <br /> - r �- ��- <br /> zed agents signature certifies the fallowing: 1 *a T - <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> f� as to become subjec fo W kman' ompensotion laws of California." <br /> I Ji .i <br /> Signed .: . ....__. .. •- ---------------------------------- wrier �... <br /> BY .._. .. .. . . ....:.:..:,Title'. ....................... <br /> E (If other than,owner) " -,. <br /> E FOR DEPARTMENT USE-ONLY <br /> APPLICATION ACCEPTED BY ... .� r j.'�... ....... ....... ...................... ............ ................ DATE ......f .' :. 71—,1 --• <br /> BUILDING PERMIT ISSUED ... ........... ..._DATE . .................................. <br /> ADDITIONALCOMMENTS ..... • -------- ------------------------------=---------------- ----- ..............................----._.................... <br /> j ---........:...................� -••------------ �. . ........------T--. ..........M'. -------`--- ..............................................� <br /> If/ <br /> ' E <br /> Final Inspection b : ...... �__.. .. ``•..-; -''� � Date .. l �'`' r <br /> SAN JOAtOVIN.: LOCAL HEALTH DISTRICT <br /> ,. 1 '3 7 <br /> 47177 'A H <br />