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FOR o1=Flci: USE: <br /> APPLICATION FOR SANITATION PERMITY��3 <br /> ....._.................. ._.,-- - : _--- Permit No. - <br /> ICam--------------------- Vplete in Triplicate) -------- ------- <br /> 1r Date Issued�D.`��.' . <br /> .................�.{. .k-.. .--............._.... This Permit Expires I Year From Date issued <br /> Application is hereby made to the Son 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. 549 and existing Rules and Regulations: <br /> 112�.7 No. �4,1P..ne.................................................. ..--.CENSUS TRACT i-/---------------- <br /> Owner'sJOB ADDRESS/LOCATION 1 ----- ------ <br /> g col en - - -- ••------- -•- - .Phone9� - 7--------- -.... <br /> Name �..._..:_.:. _ _ _�._ �D2. <br /> Address ------76,20..Na.--.Ell]arada....._.____•------------- �.�__.�,__ ._:. Clry __......__5tkrz. <br /> -- <br /> Contractor's Name BI a ckarc3's--—— - Tank-- ----------------.......--.License # -___26 9S_1.... Phone _- h,3--_7 <br /> Installation will serve: Residence [3 Apartment House❑ Commercial ❑Traller Court ;❑ <br /> Motel ❑Other........____------------------------- <br /> Number of living units:......1.. . Number of bedrooms .._9_____Garb0ge Grinder Lot Size ..,____- .._ C ' D„_._____----- <br /> Water Supply: Public System and no me _____ —_____________________________._�. __,Privatef] <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay loam ❑ <br /> Hardpan ® Adobe ❑ Fill Material ..... ...... If yes,type ------------•-_........... <br /> .. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on rerierse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-------_5_i x.6_�_'XlU'------...._....... Liquid Depth --- $�.......... <br /> Capacity ...._z fl .... Type .-- q'-----_-.. Material----P_af:?-t,�------ No. Compartments ----2___•-____-__--- <br /> Y <br /> Distance to nearest: Well -_.-------B_Q_'____________________Fgt'Yndatian:....10 ---------- Prop. Line ----------2ao-k - <br /> LEACHING LINE [ j No. of Lines ------____-- Length of each linar�....._S4~--- Total Length 0.r <br /> -- .............. <br /> 'D' Box ..1........ Type Filter Material ----- _______-Depth Filter Material .-...........19'-'--------------------- - Y <br /> Distance to nearest_ Well ._1QJa ...�-�....-Foundation .�*---------------- Property Line .Z00... <br /> SEEPAGE PIT [xj Depth ---.__ ------- Diameter - "---,_.-. Numbs- ....._.. -.-------------... Rock Filled Yes E) No ❑ <br /> Water Tabli Depth _ 99_'_-----_:- --_-_:.__-=.Rock Sias _.....-----2"......:......... i <br /> Distance to nearest: Well -----------1D_4_'.__.__._•-----__----Foundation Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------•----------_.__•-------------......... Date --.---------------------_._-_-_--) <br /> Septic Tank (Specify Requirements) -----------l2a0-- Gal-. <br /> Disposal Field (Specify Requirements) P- ts---.3-3",X2 �---------- <br /> ----------- <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 Son Joaquin <br /> County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed -----•------------------ - r------------ _. Owner -. <br /> - ..s..c. X...._.. — ._ Contractor <br /> By .. ---------------- lisle .... ......................------------------ ..........----- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- - ----------- - -- ........ ....----_-•_.-----.-_--- ---•--.------- _, DATE _r�_. .�'�_"�� <br /> ------------------ ---- ---------------- <br /> BUILDING PERMIT ISSUED ------- -----------------------------------------------•-------_------—----- -�. _:___�_:------DATE.......................�­­-­­ <br /> ADDITIONAL COMMENTS ...... ................----------•-------------------------_.................. --------____...........--... -....-----•-----•----- <br /> ------------------------ ---------- <br /> ----- <br /> — - ... --------- --- - -----•----------- <br /> Final Inspection by: _ - ---------•----------------- --.Dctte�$�_�_'� .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1268 Rev. SM <br />