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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR-SANITATION PERMIT <br /> ------- •--------------- <br /> (Compiete in Triplicate} Permit <br /> - .-----•------- � y <br /> _ ._�...--- ------------- Date Issued----�:�Q -_7 ' <br /> •--"•-- - --- ---------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.....!_.�Z6 ... (44.IN S7�/��.---------- CEN5i15 TRACT....- *•--..---- <br /> Owner's Name...- SQE.--.--T!i Cc.e 5 ................ ......=------Phone.. ./ _--%./0 ------- <br /> Address <br /> - ---- <br /> Address .Z�.. Ci �2If1.- Cit �TK ' <br /> Zi '..... <br /> Contractor's Name......t11s. '# Q S License #_.42. :`Y.- 7-�.Phane._. �E _- .p. .. <br /> Installation will serve: Residence Apartment House ❑" "Commercial ❑ Trailer Court ❑ <br /> 'Mode-I Other- T <br /> Number of living units;---...../.------Number of bedrooms_..Z.....Gc4age Grinder...-._....--Lot Size------- .......... ..... <br /> Water Supply: Public System and name------- --- -- ----------------- ------------------------------= -------- Private . <br /> Character of soil to a depth of 3 feet: and Silt R, '/_CIay ❑ . Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe <br /> Fill M terialt_ ... ._...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.) J <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Size ------------------------------- <br /> Liquid a <br /> Depth..._-�......------- <br /> capacity,.. <br /> ------Capacity,. 1 0-0: TYPe -RECT....:M 1-0-1_..-004/4!::�;-- No.' Compartments........Zr------- ----- <br /> Distance to nearest: Well--------'`TU.�`t7.._;... ..............Foundation----- �" - --- . Prop. Line__.-moi- --..-.----� <br /> LEACHING LINE [v)_ No. of Lines ..........'7 .............Length of each line......... -.---------Total Length .__-_----�. ---._-_ ---------- <br /> D' Box.._✓._Type Filter Material___-. _f?..-- .---Depth Filter Material--- ---------------------------•- _---.--_-----.--.--------� <br /> Distance to nearest: Well--.- ......_. Foundation__._/d_­/­"k_--------.__Property Line.................................... <br /> (1.]� Depth.../ ._....Diameter............./�.Number--- _.------__ _`^- Rock Fi!!ed Ye No ❑ <br /> ii t er <br /> SG/iyl/� Water Table Depth.................................- -- ---- Rook Size._ .3 �.X�J/a- ........... <br /> Distance to nearest: Weiin...... .......Foundation.... _..Prop. Line.__.5....'�" <br /> REPAIR/ADDITION (Prey. Sanitation Permit#_._:--______. :_......F....._. ...............Date`'---_:-------........... ---- .1 <br /> Septic Tank (Specify Requirements).. <br /> Disposal Field (Specify Requirements). -' -------------------------------------------------- --------------- -------- <br /> ----------- <br /> ------ <br /> .........-- <br /> .. ------ F .}--- ------------------------------------- <br /> 7 <br /> -------------- ---- ----.-.-----.. <br /> ` ............... .. ------------------ _- .-.-------------- -__--- . ............................r.._._....._ .. -- _.. ._------------ ___ <br /> (Draw . <br /> existing and`required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work;will'ib"", one in accordance witlf San Joaquin Count <br /> Ordinances, State Laws, and Rules and Regulations of _the 5a-'Joaquin Local Health District, Home owner or licensed agents \ <br /> signature certifies the following: N <br /> "I certify that in the performance of the work for which_ this permit is ri$Sued, I shall ndf employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed------- Owner <br /> By-------- �y ----------- ------- ---- - - --- -- --Title._....----- .S ]`�6Y1 -T . <br /> (If other than owner) <br /> F R DEPAR MENT U E ONLY <br /> APPLICATION ACCEPTED BY.... ....... . . ....... - ----------- ----- ...------ ....... <br /> DATE .......... 7 ............ <br /> DIVISION OF LAND NUMBER ..... _---.- .......................--- DATE . <br /> ADDITIONAL COMMENTS......_ iu- -�-0!1- / e ✓�- '°'", <br /> .................... -- . ....-----......----- ........._...-------------------- ....... ------------------ ---- - -------- - ----------------.. <br /> ---------------77-------------- ------ --- -------------------- ......--- _ --..------------- , <br /> Final lnspeciion by:... --- ---Date.- =�----- <br /> EH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M <br />