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FOR OFFICE USE: FOR OFFICE USE: ] <br /> APPLICATION FOR SANITATION PERMIT R <br /> ------------------------------- \ <br /> [Complete i 1 dplicate) Permit <br /> Date Issued_-3T f <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 /> r r <br /> .-'...�.---.CENSUS .TRACT----- -------- -------- <br /> JOB ADDRESS/LOCATION -- ----- -- - -- ---- ------- - <br /> Owner's Name------ ----- _ ------ Phone z <br /> Address-. t - ------ ---- ------------City-- -- _ -- ---- - ---------zip -- ------ <br /> Contractor's Name_ l --_ .4,%,x_ _.AU_xzA,icense #_OZ_5 r /.,_-7__Phone ------ ----- <br /> Installation will serve: Res denceX Apartment House❑ Commercial ❑ Trailer Court ❑ <br /> I Motel ❑ ' Other---- --- ----- -------- ------------- -------- <br /> l - ' <br /> Number of living units------- __.------Number of bedrooms_�.___Garba e G_ er_. Lot Size_____0 x3_____ --------- <br /> Water <br /> _ _____-Water Supply: Public System and name----- ----- ------ ----------------------- ---------------------------------- -1--Private'❑ <br /> w <br /> Character of soil to a depth of 3 feet:r Sand [] :Silt ❑ Clay ❑.it Peat E] Sandy Loam ❑ Clay Loam ❑ <br /> - - ' <br /> Hardpan ❑'; Adobe FilFilI Materidl.' _____Alfyes, type ----------------- I <br /> t t <br /> (Plot plan, showing size of lot, location ofysystem in relation to;wells, buildings, etc.-must be placed on reverse side.) ' <br /> NEW INSTALLATION: (No. se tic �tarnk' or seepage-R.it permitt blit sewer is available within 200 feet.,}''°" > I <br /> PACKAGE TREATMENT <br /> ] [ SEPTICi`TANK• [ ]�°Xs * _ __ _________Liquid Depth.' ` __ ---------Ca acit , Type. . . ' <br /> No Compartments _ = I---- I <br /> Distance.to nearest:.Well �. _ # __- Foundation i Pro �L'-irae4:_._._ <br /> . _ f� p. C' <br /> LEACHING LINE. No. 'of Lines /, - Lengfih of each :iris Total Length.__ + ;-`.---_:_ __ <br /> l D' Box. -..Type Filter MpterialF/ _ _ Depth Filter Material __ __ ,--. _ _ _ ----- <br /> -- <br /> I :Distance,to nearest: Well Foundation _ .__--.-_ !--_Property Line'_. -j " <br /> SEEPAGE PIT Depths �,: Diameter �` f -----_ '" ❑ <br /> ----Number------- --------- -- Rock Fllled�Yes No <br /> ] Water Table Depth- ---- --V_' -----=--------------------------------Rock Size-------�- --------------- -' - --- , <br /> Distcsh a to nearest: Well-' Foundation.---:--- Pro Ltnef_ t <br /> I 'f ' — fob- P - ; <br /> REPAIR <br /> /ADDITION (Prey:Sanitation Permit#tea _.__ - _I---- -- - Date - f <br /> Septic Tank (Specify,Requirements) .-. ------- :_4p.-_ -------- --------------- <br /> ---------------- <br /> -- -. : <br /> : . ,F <br /> Disposal FieO,(Specify Re. uirements <br /> : - ..--- <br /> ________________,______- _------------- ---------------------------------------------------------------------,_--__--____-__._-____-..___.____.___.__________--.--._----.--_-.__-.--------------- <br /> l Dra_ .ter_ w ekxisting and required addition on reverse side) j <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 the following: <br /> "I certify tKaat-in the performance of the:work for which this permit is issued, I shall tnoemploy any person in such`manner as <br /> to become subject to .Workman's Compensation laws of California." <br /> Signed----- --- --- -- - --- ;----k=------=----------- --- ---: ----Owner CLAIRMCE'.S SEPTIC & SEWER SERVICE <br /> ,�/ <br /> B `y -------Title-----=-----�hfi3 So. Oro Stockton., Calif, + 5 05 <br /> Y t <br /> (If other than o �r, F <br /> �� -3209 .Cont. <br /> ^" FOR D MENT USE ONLY", <br /> APPLICATION ACCEPTED; BY- - _ DATE. ,- --------7........... --` ----- <br /> DIVISION OF LAND NUMBER:` -------------- <br /> --- DATE._-- <br /> ------- <br /> ADDITIONAL COMMENTS _ _.4, /Z... 7 --- <br /> --------------- --------------------------------------------------------- ---------------------------------------------------- -------------------- -------------------------- ------ -------- I <br /> i <br /> ---------------- <br /> ------------------------- <br /> ------------- ------ ----- ------ ------ --- ------ -- ----- ----- -------- --- ---------------- ----------------------------------------------- -- -- ------------- ------------- <br /> Final Inspection b -- -- --- = -- ---------------------------------=--------Date '�I =' <br /> 4 <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FRS 2f677 REV. 7176 3M i <br />