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FOR OFFICE USE: FOR OFFICE USE: <br /> VAPPLICATION FOR SANITATION PERMIT <br /> - ----------- <br /> (Complete in Triplicate) Permit No.7;F7�' -. ...-- <br /> Date Issued--/.4-r)f.-75" <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 ismade in compliance with.County,Ordinance No. 549 and existing Rules-and.Regulations: <br /> n TRACT. F O_-•---------------------- <br /> JOB$ ADDRESS/LOCATION--..�.���.~.�..�.;.� .........- ------- -- ------- --- -- .'.---.CENSUS <br /> r , /� <br /> �. - hone " <br /> Owners Name -.....:._ .. t<.:Af41,d . .. I Ill. ... .................. . ..... ..... ........... .... :---- ---P ..... _.. . -- ...... <br /> Address. -------- ..,. ._........ a `rb Cit Zi ' -- <br /> - --- - . y ----------------- p `...--- <br /> f <br /> _ _ _ _ . . ------ .License # - <br /> Contractor's Name...:..----�--4-t�.+'t..��� � ....------•................ . ..._. ,.Phone--- -- <br /> Installation will serve Residence ❑ Apartrrment.House �] Commercial ❑` Trailer <br /> r <br /> _,T....._.» «.t v ..�_. . -Motel; Other.-.:-..`::... = :=__._ <br /> . . <br /> T �Y• r <br /> Number of living units:......._ ._.__Number of bedrooms_^�. .-'Garbage Grinder___.._....._Lot Size__.. -�.�. <br /> Water Supply: Public System and name.. ..... - .`------•----------------- --- ...._.-- --Y-- - PrivateXS <br /> Character of soil to a depth of 3 feet: Sand ❑ I Silt❑ Clay ❑ Peat-0'Sandy Loam K Clay Loam ❑" } <br /> bard pari ,R f <br /> 1 � p � ❑�.�Adobe ❑�- Fill-Material.. -- if yes, type-------------------------------- <br /> (Plot, <br /> •-.-----------................(Plot plan, showiiig-size,of°lot,locati.o of-system in relation to wells,'buddings, etc. must be placed on reverse side.) <br /> F 9)� w <br /> 1 NEW INSTALLATION: (No ;septic tank or seepage pit permitted itfpublic sewer is available within 200 feet,) . <br /> . --------1 PACKAGE TREATMENT SEPTICTANK Size Liquid Depth.._.::. W <br /> - <br /> Capacity-�P��fv ---------No. Compartments..___ <br /> 14 " <br /> 1 1 t -Disiance.to nearest: Well:._-.._. . ... '�..... __......Foundation_...��1 . ... ' -_Prop. Line-----�--- ------------- <br /> LEACHING LINEr." No`of:Lines_. . ::.-.:-L :_-_-_-- Length of each line.----G�= ( .---...... Total Length .. .._ �:.._LB(L........___. <br /> 'DBox-ti ...Type Filter Mat.erial""_ 'GAv,,Depth Filter Material_ .- -��-----� ............... .. ---- <br /> pp / /r <br /> ce,to nearest: Well:--i-,S -. -.Foundation------140---- ---Property Line..-._ ._....----- <br /> Distan �- <br /> SEEPAGE PIT <br /> p h.yt ......Diameter..T-X_..Number-------------------------------- Rock Filled Yes No <br /> �!Watetj.Tobl:e Depth.:---•----------- � '.` - :::...-.�':_:Roek.Size........... . <br /> Distance to nearest: Well.-------- Q.+� - <br /> -------------------Foundatio .......Prop. Line----S- ------ ...----.- <br /> REPAIR/ADDITION (PFev. Sanitation Permit#---------- - ----.----------Date..................... ------.----.-----} <br /> Septic Tank {Specify Requirements)...... .... -------- '----- ------------------------------------------- --------- --------- .-..................... <br /> Disposal Field (Specify Requirements)...._.. '-------- - '-- "` ----­------------- -----_- ...... <br /> ------------ - ------------ <br /> (Draw existing and required 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 the following: <br /> ( "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as <br /> to become bye to or an's Compensation laws of California." <br /> t <br /> Signe .... <br /> ...Owner. <br /> By......... ------- --------------- •- ...... ------------....------.....----....... Title. . ........ ------------ -_-_-------- ---....-- <br /> (If other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BY------------... ............... .... .DATE <br /> --------------------------- <br /> i DIVISION OF LAND NUMBER _............. .:.......... . <br /> - -------------------------------------- - •-.... -------- --- ---.....DATE....----,-.....:- '-=-- � ...... ,......... <br /> ADDITIONAL COMMENTS-- ----------------- --- ---------- <br /> --------------------------------- <br /> ------------------------ - - \. <br /> 1 <br /> l <br /> -----••--• ........................... �._.-----•._..------------------------ .......--- . ] <br /> Flnal'InSpeGilan b i� V"? ....._ ..... <br /> y:... Date <br /> ek 13 2" SAN JOAQUIN LOCAL HEALTH DISTRICT F&s1�SP" 7/76 3M <br />