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FOR OFFICE USE: <br /> FOR OFFICE USE: <br /> /- -APPLICATION FOR SANITATION PERMIT <br /> v'FJ° _ Permit No.7$'=- S'1_,. <br /> (Complete in Triplicate) <br /> ------------------- �' � �' --.� . FDate Issued_W:�-=,715" <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 RuL'es and Regulations: F <br /> JOB ADDRESS/LOCATION--,---- - _-- - <br /> a - <br /> ------:_.CENSUS TRACT 1 .__------ <br /> Owner's Name:: Phone_ <br /> ------ ------ -- ------- ---- <br /> k <br /> Address --._ Q 3- - <br /> ¢� <br /> .. <br /> -- � - .City. -�_-- Zip <br /> Contrator's Name. <br /> --------------- <br /> c' '` { /.� ice <br /> i ,, License �# p -� Phone.-,'ylo sG� <br /> Installation will sexve: Residence0Apartment House. Commercia� 1�0 ^Trailer Court, <br /> t .. t ---------- y, <br /> El <br /> .f!/Notel_E],u-Other�._M- : --- _ !' F <br /> Nu'mber.of living un.its:_:-_�___'_Number'of bedrooms_,�_---.Garbage.Grinder----------:-Lot Size------------- --------------- --------------=-- - <br /> t= <br /> 1 <br /> Public System and name---- .........:---------=-- ---- ---------- -.•-- ---- ---- --------------- -_ <br /> Water Supply: y --. r. _ ------Private <br /> -.. <br /> Character of'soil to a depth of 3 feet: Sand-❑—Silt E1"'_Clay�— Peat ❑Sandy Loam ❑ Clay Loam F1 <br /> Hardpan E] Adobe. Fill Material--------_--_If yes, type-------------'----------------- <br /> [Plot plan,fshowirig,size of Iat, location of system in relation to wells, buildings, etc.,must 6e:placed on.reverse side.) <br /> i <br /> NE*_INSTALLATION:`' !(No septic tank 'or seepage pit permitted if public sewer is available within 200 feet,) <br /> i ; <br /> PACKAGE TREATMENT' [ j' SEPTIC TANK t[;l -•,Size--------------------------.'--�"--`------;---- ------------ <br /> -Compartments <br /> Depth-------------- `---- <br /> k ---- <br /> Capacity-:-, '--- ---Type------- �'.__Material-- ---- -`--- -- -Nos'Compartments <br /> Well- ---- - --- -----------------------------Foundation---- = --:----Prop. Line--• --------.F <br /> LEACHING L--INE: ( .] No, of Lines- g -= <br /> Distance to nearest: <br /> Length of each I nil a.: -'=Total Length -------=----------------------=------ <br /> - ~ _ --------- --------- . <br /> l Depth Filter Material ---� <br /> D' Box.-'--- <br /> Dist: <br /> ox._-- T a Filter Materia -------------------- <br /> 1 - ---------------Property Line----------------------------------- <br /> b <br /> --------- ------------I <br /> DE th_- Diameter - Number = € <br /> Distance to nearest: Wel!____________________ __ _ _ Foundation_-____.____- - <br /> SEEPAGE PIT [ p Rock Filled . Yes ❑ I No ❑ <br /> --- <br /> i Water�Tab a Depth.- _ = ::__.. _ ---LL----Rock <br /> k Size--------=-------- <br /> Well dProf• Line---------------I <br /> ----------- <br /> # a : ` „- Founation- <br /> REPAIR/ADDITION (PrevSanitation Pemit# - `Date--------------------------------------------- <br /> ----------- <br /> Septic <br /> - `----------- ------------'=--- <br /> SePtic Tank (S ecifY.Re uire'ments]---- ----- -------- _ , ---- <br /> -----•--� <br /> ------------ <br /> ----------- <br /> ---------- <br /> , �--- � �------el (Specify Dd - -� <br /> ---- --------- "- ----- ------ <br /> � ' <br /> (Draw existing and required addition'on reverse side) <br /> 1 hereby certify thatJ'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'the following: <br /> Fla <br /> "I Certify that in the performance"of'the work for whith'this permit is issued, 1 shall not employ any person in such manner as <br /> to become su t t Workrin s Co pensation laws of California.".. - <br /> VT/ --Owner <br /> Signed - - - ---- - <br /> BY - { - TitlE --:-- - <br /> (If other than owner) I <br /> `FOR DEPARTMENT"USE ONLY <br /> >! ; . <br /> APPLICATION ACCEPTED.BY-- - -- ---------=----------------- -------=------- DATE �� �- ---------- <br /> :---DATE-- - ----- ----- ------ <br /> DIVISION OF LAND NUMBER-------------------------------------------- -- - -- 1 - ax. - <br /> ' �C .- <br /> ADDITIONAL COMMENTS-------- -��--� ----�- � «•----- ----- e- �- --- ------------------ ------- <br /> -- <br /> - -- <br /> -- ------------- --------------- . ----------I--,----------------------- --- ----------------------------- --------------------- --------------------- - ---------•------------- <br /> 4j , <br /> --- <br /> --- ----------- --- <br /> -------- -----• ------- -------------------- <br /> ----------------------------------------- ---- --------------------------------------------------------------: <br /> Final Inspection by - — P"" 4 `"`_ <br /> --Date.---��_ _ .------ '-------------- <br /> k EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21�. 7/76 3M <br /> ( 0 , <br />