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p rvx Urrl(g i15t:r <br /> ....... .-�,-).2............(��fl.� A ILMAI'fON FOR SANITATION RERIVIIT v T <br /> ........; _---- #Compfeh in Yrtptfsaief Permit Na. . �:.�� _- <br /> :°..................................................... . T �.,lhti P�rmlt Expires 1 Year From Date Date._lis-lis <br /> issued- <br /> Application Is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the.._work-hereln <br /> .-clescribed..This application:is made.ln compliance with County Ordinance No. 549 and-existing Rules and Regulatfonse ± <br /> -�'=Cf�(-N-•�C.��.J£Gam. ��y ��: `..... r ..... ........... .. ^ i <br /> JOB ADDRESSAO,CATION .......- `f... <br /> ......;� ... .GIIVSUS TRACT ............ .... � <br /> 'Owner's Name � _ ......... <br /> Address ...-......�..�..�. .............. .. ._ . .. '. ..........:.---- -•::.,�........... ... one ............................. , ... 1 <br /> Contractor's Name .. lR•. t.Lican:a # a <br /> `ll'�`_.7 Phone ..+P <br /> Installation will=serve~ - -. -Residenceb'Apartment House Commercial ❑Traller Court ❑ <br /> Motel❑Other................................I........... <br /> Number of livings unitss_._./... Number ofberooms .�GarbagsJGri�nder .`�: Lot Size <br /> ....... <br /> Water Supply, Public System and name _ .... . .... ; ....... ..Gr .. ........ `'.' ,....---..... ..i.�� <br /> ._............... ...... .......Private 13 ► ' <br /> Character of$oil to a depth of 3 feet, Sand b Silt❑ Clay ❑ Peat Sandy loam ❑ day Loom ❑ <br /> - Hardpan.❑ (Adobe EIII Material............if yes,type....... <br /> (Plot plat, showing size of lot, location of system in relation to wells, buildings, etc. must ba plated on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pV peri If public sewer is available within 200 feet,! •1 i <br /> PACKAGE TREATMENT SEPTIC TANK( I •S 'PD <br /> I ] ze---•....................._..................:... liquid Depth ......................... <br /> Capacity .................... Type .................... Material...................... N& Gampartme !!t..,........ t <br /> Distance to nearest: Well ....................................Foundation .................. Prop. L1,t$'�h <br /> LEACHING LINE—"c No of Liriei .....__. ... Length of each line...... ...... Tata! Lengh ..�.. .......... <br /> 'D' Box .. Type Filter Material . . ..Depth Filter Material ... �`,,i'- -elw'......... ..........- <br /> Distance to nearest: Well .r�11 Foundation . e..'o......... Property�'Vne :�~ (..........x <br /> SEEPAGE PIT Depth - -•. Diameter Number ....... .. - -(lack Z_ e _.Filled Yes N <br /> — .. Water Table Depth ...... `. :...:.......: .............Rock Size`.`: ....................• a �? <br /> Distance to nearestc Well , ``� '"'" r 'J '"" t �1 r <br /> .Faundattart. Prop. Lute . ..... <br /> R PAIR/AQDITtAN(Prey�.Sanitatlon Permits _ .... ....... ...................... Date ............................. <br /> Septic Tank (Specify Requirements) ............: . .... ......--- '„ r". <br /> Disposal Field [Specify Requirements) $- .._.... . .'' . . .� .. ... <br /> ................ ... ........ �_. :. -. :_-... ........:::. <br /> ................. .................-•.--..... .................. <br /> _ .........._.........__....... x <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 z <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven. <br /> sed agents signature certifies the following- <br /> it I <br /> ollowing-"I certify that In the performance of the work for which this permit is Issued, I shall not employ any person In such manner <br /> as to became subject to Workman's Compensation laws of California." <br /> 1;LARENCE'S SEPTIC & SEWER SERVICE <br /> Signed ... Owner 263 So. Oro <br /> ••--•-••• Stockton, Cala. 95205 <br /> ' P__h.46.3-3209ontractar's Liv. 6 1 <br /> By ........ ..... . title <br /> A�ather han owner) <br /> ..................... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ............... .......---....... DATE�� -. -.� .Z-----....... ! <br /> BUILDING PERMIT ISSUED ... .. DATE <br /> ADDITIONAL COMMENTS ..... . <br /> .........:....................................�...�-�.-.:��..............::::�'.... ::: ................................................:::::::::::: .....::_.........:: :...... <br /> ... ............................ •--.... .........--........... <br /> --...--....---........................................ . ... .. <br /> .................... <br /> Final Inspection by: _.....- . Date _......... <br /> ........•. a e ..... ... .... . . .... <br /> Fri ].3 2a 1-bli lfcty .. . <br /> SAN JOA[ LOCAL HEALTH DISTRICT <br /> 8/7h 3M <br />