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FOR OFFICE USE; FOR OFFICE USE: <br /> ` APPLICATION FOR SANITATION PERMIT /i <br /> .... <br /> [Complete in Triplicate) Permit o .....--- ..-....._... <br /> .............----------•--._............--�..-.. <br /> Date Issued.-�...:�!I�!,!, <br /> ......-•••-• .---.•. ........... .......... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made fo.the San Joaquin Local-Health District for a permit to,eonstruct and install the work herein described... <br /> This application is made in compliance with County O'rdinance.No. 549.and existing Rules and Regulations: <br /> n • <br /> JOB ADDRESS/LOCATION­ 3.42.. -- aApa.N4le-L & ------------------- ..........CENSUS TRACT....................... <br /> Owner's Name.... 0RA"'a-11....Ko.f .......:--- - <br /> .......................................: ..----•-•-----....... ..... Phone.fcz _ Jam. d-....:.... <br /> Address--------- ........:.'...................... ....................................... . ...... ........City-----------.-.................. Zip------ ....... ------------- <br /> Contractor's Name-' A�-:�----� ?27740A,{ s� <br /> ..: . _ f� `..._hlr_C.- .License #- �jf� `� Phone.. .: ? �.._. <br /> Installation will serve: ResidenceX) Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> ° Motel ❑ Other............ .....11-------------------------- <br /> Number <br /> - - -. . .--- - -Number of living units:....... __._.Number of bedrooms..-....Garbage Grinder_ Q_.-Lot Size.... c 6:: <br /> ! Water•Supply: Public-System and name..::,.--.: - __ .-..: ... ... ......... ....... ­...------------------ -------. ..---- ..---.-------------- ---.Private <br /> } Character of soil to a depth of 3 -feet: Sand ❑ Silt ❑ -Clay ❑ tiPeat�❑ Sandy Loam ❑ Clay Loam ❑ <br /> - Hardpan ❑ Adobe Fill Material ....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.). °� M <br /> NEW .INSTALLATION: (No %eptic tank or seepage pit peffirtTdif public sewer-is-available•within 200 feet,) A �; <br /> PACKAGE TREATMENT SEPTIC TANK Size.... ., ------------"l — f <br /> 1 ::..........Liquid Depth._ ' . <br /> Cdpacity 1249'.-------TypeW� : .s �. Material. �-42;.�7No. Compartments......V1------ <br /> ------------------ <br /> F Distance to nearest: Well.._..> .. .............Prop. <br /> r � � rLine--.?.�...._._...------ <br /> LEACHING <br /> __--_ <br /> LEACHINGLINE No, of Lines ................ .Length of each line....._ Total Length ....... ...............{�v.. <br /> NI <br /> 'D' BoxN.d...Type Filter Material-,R6 rk-. Depth Filter Material....._.. ._. ................................. <br /> Distance to nearest: Well-..... ----- Foundation------ -Q._r............Property Line----------------- <br /> SEEPAGE <br /> .... .....SEEPAGE PIT �J Depth--- .<J....Diameter-_ .....----Number....-�----------------------- Rock Filled Yes No <br /> _.. Water :Table Depth----- ----�- ---- - ..........Rock Size.-.-/--/a--., 1-........... <br /> Distance to nearest: Well....../00).................----------Foundation---- ._............Prop, Line- P---. _..... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-----------------.......-------------- -------------Date............. ...................._.----.-) <br /> Septic Tank (Specify Requirements)- ----- - •-- --------- --------------------- ....---- <br /> DisposalrField (Specify Requirements)........................ ... -- .-- ------------- ..............:...---------- ----------•----._....----------------....-.. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and tkcit 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 /> t "I certify that in the performance of the work for which this .permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws. of California." <br /> 1 , <br /> Signed = ----- ------- ----- Owner <br /> By..--•------------------ Title --- . .. ...---.... <br /> t , (If of r than o tier) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -------- - . ...• .­­.................................. -------------------------------------DATE.;_-....r/L-.7 .. - _---. -----.... <br /> DIVISION OF LAND NUMBER...------ --------------------------------- DATE :.-. _..... .....-- <br /> t ADDITIONAL COMMENTS- ------------------ --- ------------------- ---- --------------- ............-- - <br /> ? -----------------•-•- -- --- � �`�`L� -- <br /> --....... <br /> - <br /> --..-..- <br /> ---- <br /> -•--------------------------------------- , - .. __Final inspection bY' <br /> Eit F <br /> 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras 21677 REV. 7/76 3M <br />