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FOR OFFICE USE: <br /> FOR OFFICE USE; <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------------------ <br /> {Complete in Triplicate) Permit No.77'____ ------- <br /> Date I ssued- <br /> ---------I------------------------------------------Y- This Permit-Expires I Year From Date Issued <br /> Application is here'by.made.to,the San Joaquin Local Health,Dist.rict 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/LOCA ION..-.-. _J_ <br /> --- <br /> ------- ---- ----- . . ...... ---------------- <br /> ......CENSUS TRACT-__.-- ------- ------------ <br /> Owner's Name-------- <br /> ---------- Phone-------------- --------------- <br /> 2 city <br /> --- --------- <br /> Z i p_/C ....... <br /> ------Address.------- <br /> Contractor'sL i cen se #4 �17 ___ <br /> Phone-. -," ,__--License <br /> Installation will serve: Resid <br /> nce Apartment House rCommerdal'b <br /> ;Trailer CourtZ&el <br /> ❑ Other-------- <br /> --------------- <br /> J <br /> Number,of living units------ ------Number of drooms -------G'arbage Grind4r--.t11___Lot'Size_C>e <br /> - --------- _ <br /> Writer Supply: Public System and name--- <br /> Z8 T 0�Ml_ -- - ------------- ----------------------- ------- --- -------------------------- <br /> -PrivateA i <br /> Character of soil to a depth of 3 feet: . Sand [:] Silt El Clay ❑Ji Peat F] Sandy Loam E] Clay Loam L] <br /> Hardpan EJ r! "Adobe,Ae'r Fill Material <br /> yes, type---------- ---------- ---------- <br /> (Plot plan, showing size of lot, location of system 1'n relation to wells';-_buildings,-etc. must be placed on reverse side.) <br /> {No'septic"iank'or seepage it permitted:if-'public sewer*i'sL`a�ai I able within-200 feetJ <br /> NEW INSTALLATION: <br /> PACKAGE TREATMENT SEPTIC TANK Size--- X-1-0- -- --------------I I Liquid Depth-_-%S'- ----------------\J� <br /> -4r CA4-Ty - -- -------- Na. Compartments-----Capacity 4L* g------------------- ------- -- ----------Foundation._ 7 ----------'--Prop. Li -'s--------------------- <br /> Distance to nearest. Well.'. ......tj <br /> ne--- <br /> LEACHING LINE No. of Lines_,7.-.-.-/-------------------Length qJ each line_--/047 1' Le'gth <br /> ---------Tota n Af7e <br /> ---------------- ----------------- <br /> 'D' Box. t5F- -Type Filter ------Depth Filter Material--- <br /> I - r4 - _' - . F. . --- ------------ --------------------------------- <br /> 'D istance to nearest: ; 11 '.. / <br /> arest: Well.'s7e_!°_-_.-_._.___.-foundation---_ -11 - Line'. <br /> I .. .,. . -Foundation----A r__'._-_-__.__.Property-----------Property WS------------------ -------- <br /> SEEPAGE PIT Depth,_ Diam'eter__��_,-------Number... ------------- Rock Filled YesNo E]�V <br /> A <br /> . ------ - 7Water Table beptk - -- ----------RockS Size <br /> W7 --- - ------------ <br /> Distance to nearest: Well-- ----------- ---_Foundation:-___ _ _______.Prop, Line --------- - -- <br /> REPAIR/ADDITION (Prev. Sanitation Permit <br /> Date-------------- - - --- ------- -------- <br /> --------------------------- -- --------------------- - <br /> Septic Tank (Specify Requirem- <br /> e 'ents)---------- <br /> Flew------- <br /> -- -------- ------- -- ------ ---------------- ---- -- ---- <br /> pquirem6nts)._ <br /> ------------------------------------- --- <br /> Disposal field (Specify R' <br /> ------------ - ------ <br /> ------- <br /> ------------------------ <br /> --------------------- ---------------- ----------------- -------- ------------------------------------------------ -------- <br /> ------------- ------------------------ <br /> ----------------------------------- <br /> ------------------- --------------------------- ------------------ -------=-------------- <br /> } <br /> ----------:---------- <br /> ------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I ha've prepared this.application and-that-the work will I be d.one in, accordance with Son 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 /> "I certiN'that in the performance of the woik"for- which this permit is issued,A shall not employ'any 'person in such manner as <br /> to become subject to. Workman's..Cam p6' nsation Jows,of.Call fo <br /> mia." <br /> Signed-------- -Owner CLAREl'ICE'S SEPT:'� & SFVIER SERVICE <br /> ------------------- -------------------- ----- ------ <br /> r <br /> ------------ <br /> 263 So. 0 c C.'a5f. �)5205 <br /> By-I.- <br /> --------------- -----Tit --------Ph-.z4,6-3-�3-2nl <br /> offie t a oN4 <br /> FOR'DEPARTMENT,USE'ONLY- <br /> APPLICATION ACCEPTED BY- ----- ry - ---------------- ------------------------------- --DATE..//-- /7 <br /> DIVISION OF LAND NUMBER------------------------------I--------------------------- ------ ----------------------------- ---------DAT6---------------- <br /> ----------�_­--------------- <br /> ADDITIONAL COMMENTS.-.--_-- <br /> --------------- -------- <br /> --------------- - ---- _/ -------------------------- <br /> - <br /> V <br /> ------------------------ --------------- ---- ------------- <br /> - <br /> -----------I----------------------------------------------------------------------7----------------------------- ------------ -----------I <br /> ----------------------- ---------------- <br /> ----------------------------- ---------- -------------- ------------------------------- -- ----- -------- <br /> Final Inspection' by..-'--'- ---------------------------------- --------- --------------------------- <br /> ------------ ---Date --------- <br /> _,,5H 13 24 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />