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_:POR+OFFiCE u5s=: APs (CATION FOR SANITATION PERMIT ' <br />... . . ............... l:3........ (ContpleHlet Trlptfeata) Permit No. .7 :..7./. <br /> :.. .• .'. . . . _ . . ..... This Penult Expires! Year From Date Issued Dane Issued . � <br />.... . . . .............. . . ......... . ...... <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. 549 and existing Rules and Regulations: <br /> .SOB ADDRESS/LOCATIO ..... ..... �'`'` . ✓ . .........CENSUS TRACT .......................... <br /> Owner's Name .. .... .. ................... ... ............. .Phone .................................... <br /> Address .....- .92Z./. ..........Ee.�..... !rC ��........................Clty . ... ... <br /> Contractor's Name «. ! �-t-t�.-s .. . .`t�...' :`? .. :P!Z .License # Phone 11�: � <br /> Installation will serve: Residence'EYApartment House❑ Commercial❑Trailer Court 0 <br /> Mote!❑Other............................................ f <br /> Number of living unites....,1... Number of 4droorn !. .....Garbo a Pkinder . : .. Lot Size .. .ZS-�•.�.-44............. <br /> Water Supply, Public System and name ::..... '--- •........................................................Private❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Slit❑ any ❑ Peat❑ Sandy loam ❑ day Loom ❑ <br /> -Hardpan❑ Adobe C�l FII(Misterial ............If yes,type............... ............. <br /> (Plot plan, showing size of fat,`location of system in relation or wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: lNo septic tonic or seepage pit permitted if public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT I SEPTIC TANK ' Size .tys. l��... ...... Liquid Depth ... ..�... ..-- <br /> Capacity`a�G�J.I?! ,;,Ty��.tt�:e? ' Material....-t :�t.x�cC No. Compartments .-. . <br /> Distance*to nearest: Well . .. ...:.� . <br /> . .....;Foundation .r........, Prop. line .�..... <br /> LEACHING LINE+ t No. of Lines l_.......__.. Length of ach line..,lll.l�.. ....... Tota) Length / �.�.....--••••• , <br /> 'D' Box -` Type Filter Material .Depth Filter Material l..................................... .. <br /> Al I Distance to nearest: Well Foundation ��°.. ........... Property Line .... . ............... <br /> SEEPAGE PIT yj( , Depth f.... Diameter .f�... Number .1......... Rock Filled Yes Na <br /> Water Table Depth --7a..................••-. -----Rock Size .�-rte..................... <br /> /�/.......... .. ... <br /> Distance to nearest, Well .'� . ��..:. ....:........ .........Foundation _----------- <br /> ... <br /> Prop. Line <br /> REPAIR/ADDITION(P_rev. Sanitation Perinit Sts •..............•-•----_-----------__--- Date ..:...............................) <br /> Septic Tank (Specify Requirements) ..::... .. .._ ... ........ ...:............... }. .......:.....-•---............... ............._.................- .- <br /> Disposal .Field (Specify Requirements) .......`..... ........ ................•.__.........._,_._...........---_............•---•---_.....__........___...........:..... <br /> .............................�""...i.....--................................................................................................................................................... <br /> .................. <br /> ............................ ................ ................ ---......................---•-•..................................I.........-=..°...-- .......... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this applicafloet and that the work wiI# be dans In aceerelanee wills Son- Joaquin <br /> County Ordinances, State Laws, and Rulei and Regulations of the San Joaquin local Health District. Hem* owner yr [leen- <br /> sed agents signature certifies the followings <br /> "I certify that In the perfirmance.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 .......... .. ...... .. .... .. L� ..•.. ... ............. Owner <br /> ,! . title .-. .- <br /> .By ........ ... . <br /> Ili other than owned � <br /> 4 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY # ... DATE ... ... ... <br /> BUILDING PERMIT ISSUED .. - ` <br /> .........................................DATE .......... ................................ <br /> ADDITIONAL COMM 1 ® �..••••••.. <br /> •-•----•-•.. ......................•................. .....................-. ' ....... ....................................... ........................-----•----•• ..--....-...... <br /> ......... . .................................. ...•-...--- # -•----...._........... ! .........................--.................•....:....-..-......-....-.. <br /> .. .., _._ . ........ .........., <br /> .. -•............................. .:. ............ <br /> FinalInspection by..........:... --- -. .--. ..-. .----•--.-.-...----:...................................._............Date ....... .. -�. . ...71�............ <br /> �EN J.3 24 1-68 dov. 5�1 SAN JOAQUIN LOCAL HEALTH DISTRICT 8 71l 3M � <br /> J <br />