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FOR. OFFICE USE: <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT3 <br /> Permit No.-----��� - <br /> (Complete in Triplicate) <br /> --------- <br /> Date Issued_.2J.,,5' _7 <br /> This Permit Expires I 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 /> s {: -----.CENSUS TRACT------------------- <br /> JOB ADDRESS/LOCATION 7 ----�_�= = = '-, <br /> Phone <br /> Owner's Name ---- - f 1r` _ --A. ------ .- - - . <br /> Address J_____Cit -- -- --- --- ---- <br /> '3 <br /> ------- #� <br /> .. i ::. t City^ tf - -- Z <br /> �. . . •� License . '... ; <br /> Contractors Name--.---, r 4.__ -a� G'+ -- -- _---- -- °n <br /> # 1 ------------- <br /> Phone ; <br /> Installation•will serve: Residence D. Apartment House ❑ -Commercials !Trailer Court ❑ <br /> Motel ❑ Other } �--------------- <br /> Number of hvin units:__! -----. - .Number of bedrooms Garbe a Gr•lnder.�- � mLot Size . �_ ___ F - :" -F--- <br /> Water Supply: Public System and name----: .- ---7--------------------------------------------------- -- sPr�vate (� <br /> Character of soil to a depth of 3 feet: Sand 0 Silt ❑7 Clay ❑ ; Peat❑ Sandy Loam ❑ Clay Loam , <br /> Hardpan E]' : Adobe,E] Fill Material-----------_If yes, type-- -.--- <br /> (Plot plan, showing size of lot, location of system in relation to:.wells, buildings,letc.-must be'placed on reverse side.) <br /> NEW IN ATI ;(Noi septic tanklor seepage pit permitted if public sewer is available !thin 200 feet,) <br /> ::-Liquid 'Depth.-'6-4��. ------------- <br /> I" <br /> PACKAGE TREATMENT [ ] ; SEPTIC TAN ]° ; Sizer -_u "GG�� ~�C;'f-'_------- q <br /> t Capacity -- Type _ Material_..'------- -_�'No. Compartments...-. �:- ----- ------J--- <br /> / �- itq- <br /> Distance to nearest-Well: _i.!-_ .--.__ _ _-_ -� =__Foundation -----------------yProp. Line. �-.j- �=_ <br /> E I � •i i l f i = - <br /> LINE: [,] No. of Lines. • :_- - IE -----Length�of each line- �............-_ -.. Total Length : .------------------- <br /> LEACHING <br /> '{{ D' Box. .._.Type Filter'Materia 11,47,4.----Depth Filter Material--- --- _ .--_-- F- j+S <br /> Distance to nearest: Well ?Q _�_ oundation= � .__ :Property Line: _ . <br /> r 6 "t <br /> SEEPAGE PIT { ] - Depth -----.-Diameter_, ----------------Number--- ------------- <br /> Water <br /> - ---- -------------- <br /> : <br /> :----- Rork FilledwYes;❑ i No <br /> Rock Size---------------------------------- <br /> n <br /> ------ ----- --- 1 <br /> Water Table�Depth. ----- ) <br /> F <br /> i Distance"#o"nearesf: Well --- -------------: Foundation = Prop. Line <br /> - - <br /> ----"Date---------- - ------------- <br /> Septic <br /> j . <br /> REPAIR/ADDITION (Prev. Sanitation`Permit#--------------------------------'-------------'- ---------.--------- - "_ <br /> f <br /> !t <br /> f Septic Tank (Specify Requirements)— -- = - - i . <br /> DisposalField (Specify Requirements). --..:------------- ----------------------------------------- - - -------------------- ---------------------------------- `---------- ------------ <br /> --------------------------- - - ----------------- ------ - ---- -- --- -- <br /> t <br /> { � r -- ----- --- --- ------------------ <br /> _ -- -- � <br /> {Draw exisf�ng and require <br /> 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 County <br /> Ordinances, State Laws, and Rules and Regulations of--the San Joaquin Local Health District_. Home owner or licensed agents <br /> signature certifies tate following: R <br /> "l_certify that in the pe ormance of the work for which this perniit'is issued, I shall not eittploy any person in such manner as <br /> to become subject ton s mpensation laws of California." <br /> Signed <br /> f ' <br /> . . ,_ _ �...... .,.. ------- ------ ------- ---- <br /> B --------------------------------- 1t - <br /> (If'other than owner) <br /> + iF_O R DEPARTM T'USE Y' <br /> APPLICATION ACCEPTED BY-_ _ - -----DATE ---- '� ------------ <br /> DIVISION OF LAND NUMBER - - --- TE� - -- - <br /> >------ ' <br /> �_ _. <br /> ADDITION LZMM_ ENTS_ .✓�n fl <br /> ---- ----" �� �.- --- --------- ----------------------- ---'--------- --- - <br /> !k <br /> �� -- ----- ' -------------------------------- <br /> ------- <br /> -----______ __________________________.-------.--_________._--- ---. - - ...__�_ '_.____ -- ---_-.. -_.----__.__._____._-__--..----___.---.. -..__ •_-���•• <br /> Final Ins ection b .-Date. ---------- --- <br /> E11 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 RE V6 3m <br />