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FOR OFFICE USE: FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT <br /> ............................ --.,-...-:- � -x,911 <br /> {Complete in Triplicate} Permit No_ <br /> --...----••------=-------- ....---- ....---- --------- Date lssued_'�..-/..._�/. <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 Or inance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION--- d.- Q. - 6P --. .. CENSUS TRACT.. <br /> . ---------- - <br /> Owner's Name......... <br /> . a�` <br /> ... -------- <br /> .Phone. -..------- �.............. <br /> Address G� .- ------­---------- -- ......City. .- ---- �'��.. Zip' `r' ------ <br /> Contractor's Name_.`� d..'..f( -`s, ....................... ....--License #__331 <br /> Installation will serve; Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other................... .............. ----------- <br /> Number of living units:.-.- .__Number of bedrooms-./_ -Garbage_Grinder...--.-....-Lot Size.- .� ...:......:................ . <br /> Water Supply: Public System and name......... --- ----------------------- .............. ... ----------------.........Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam 0 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.). <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANKS' /4_ ------ -. !/ �2-� Ol <br /> (�� Size.- -- ...Liquid Depth...--�- - - - -.-C7k ; <br /> �� �� h. <br /> Capacity../6�Q......Type .Material.L9�r �------•....No. Compartments_- •- .-•a -- .-...--(� <br /> Distance to nearest: Well---. .�..*................... Foundation-.,I.e '_--. . - Prop. Line-.J`. -r_ -- ----- <br /> LEACHING LINE <br /> [tT" Na. of Lines ---"-..c-2_-.-••-----•-.--.Length of each lineTotal Length ............. <br /> ....�....- ' <br /> 'D` Sox_� .Type Filfier Material 'R------ -. Depth Filter'Material.-.... ................. <br /> Distance to nearest: Well...... .....-....Foundation............................Property Line.. -• - --- - ��--- - •--• <br /> -11' <br /> SEEPAGE PIT j Depth-_ S'T.,:Diameter. ............Number...-:. _..:. -- ------ Rock Filled Yes>c' No❑ <br /> Water Table Depth A. - - Rock `-...`3- -------------------- <br /> Distance to nearest: Well----/A0_Q -------Foundation....s34..... .... ... Prop. Line--_ _`. ...... <br /> . I <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------------- ---------------Date---------------------------...........---------) , <br /> Septic Tank (Specify Requirements)--------- -----------•-.... ...._ ------------------------------ ----- ....... .......... <br /> Disposal Field (Specify Requirements)..... ............. ,.....------.----.-----_-.................. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work wilt 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, I shall not employ any person in such manner as <br /> to become subjyc o WoF T n's ompensation laws of California." <br /> Signed----... ` ;...... . ..........Owner <br /> Vl. .-�1!---_.......Title �e±!1e.. <br /> By-------- ------ -------- ---------- ------- --------- <br /> (If other than owner) <br /> F&DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----... - - ---------------------------- = DATE --- ..-�� .- --- ..-.....--_... . . <br /> DIVISION OF LAND NUMBER............................. ...... ......------......---- ---- --.DATE /� • <br /> ADDITIONAL COMMENTS... ��. � ..-4,.�> - + �. e> .. '�l``"t ....... <br /> ----- ------------- <br /> -------- -----•- -•----.......,- ........... ...- .-......... --•- --------------- ------ -------------------- -- --- ------ <br /> Final Inspection b _.Date....---.--.. --- -------------- --- ------ <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />