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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT !/ <br /> - ------------------ Permit No._ �_ 7"?- <br /> // , � (Complete in Triplicate} - <br /> --------- - --------- ---------------------------- 2517 <br /> Date Issued-.,/- <br /> •------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> i. ) <br /> Applicatio is hereby made to the San Joaquiri Local'HMI'tt Dirtrict fora per .it'to construct and-if sttall'fhe work herein descries'd. <br /> This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: ! <br /> JOB ADDRESS/LOCATION -- � - CZ14 �'------ - - ----- ---CENSUS TRACT - --------------------------- <br /> Owner's Name- ---- - : ' <br /> � .. _ `:.:...; ...... <br /> --- -- -- r. ------------------ --------- a ------------- <br /> ------------ <br /> -- �------------------- <br /> �, "`� 3 `7 ,,, j <br /> =s : G ,r- ----------C�� ---- ----- -- -----Cit Zip <br /> Address + c _ ._, _ : Y i <br /> � .. y <br /> Co'ntractor's Name_ s �G - <br /> ---- - -- -- - � LicenseOT__�Ll_ �Q�� <br /> Installation will.serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ <br /> r �. <br /> Motel ❑ Ofher---- -----4-- i= ---------- --- 7 � �4 <br /> Number of living units. <br /> r-.___-Number .,1 <br /> `of bedrooms__ _.___Garbage Grinder_' =_Lot Size_____J��_____ <br /> Water Supply: Public System and name WCL - " --Private .❑ , <br /> ---- - <br /> Character of soil to a depth of 3 feet: Sand SEIt Gla y Peat Sand Loam Cla Loam = <br /> Hardpan ❑ Adobe Fill Mat erial- _J yes, type------ --------------------- 1 <br /> t _ <br /> (Plot plan, showing size of lot, location of system in relation to wells,�b`uildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: ;(No`septic tank 'or*seepage' pi",permitted if public sewer is available within 200-feet,] <br /> e4SEPTIC TANK TREATMENT ] -1 <br /> --- . Liquid Depth.-- <br /> > <br /> Capac12�04lqTYPe- Compartments <br /> rte__________r_ <br /> ---------- <br /> --Distance-to.nearest: Well--- Foundation =1- r Line =Q-- ------ ropt <br /> LEACHING LINE No, of Lines._-__-----_--- _-____ Le}gth,of each liria ----------- -Total Length ----- ------------ <br /> k------____ <br /> 'D' Box__:_l----Type Filter Materidl---A,_____.Depth Filter Material '_P F_ I <br /> rr i _ ' ------------------ <br /> Distance to nearest: Wel! . A. Founds ion. <br /> ._ � -----.Property Line--- `S -......... <br /> r,r f _ .. ' i I <br /> SEEPAGE PIT [ Depth .__'____Diameter_- k; .�.Number__. �y- .__-_-' -___ ___ - 9 Rock Filled Yes No <br /> Water Table Qepth - ----- ------=---------------------------Rock Size------ <br /> -- ---=------- --- <br /> Distance.to nearest: WeII -------------.---------j___---,Foundation__ _ ._ __._ -__.Prop, Line_ . ___-__ _._ �: _ <br /> REPAIR/ADDITION (Prey:Sanitation-Permit#--------- ---= --- _ <br /> t <br /> Septic Tank (Specify Requirements)_________________ <br /> -------------------------------------------- <br /> Disposal Field (Specify Requirements).,- <---------- - tl--- - - _ <br /> --- . <br /> _ <br /> . .-: ---------------------- -------------------------- <br /> ------------------- ----------- ------- ------------------------- i`- __________________-______ <br /> Drwl9 e'quireda8diton-r�verse side] <br /> herebycertifythat i have prepared thisappIeation and will b <br /> i <br /> - <br /> done in accordance- with San Joaquin County .p <br /> Ordinances, State Laws, and Rules :and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> x <br /> signature certifies the following: i <br /> "l certify that in the perfarmant of"ih'e-,w=orkr"fS'r wv ich-lKfs permit is 'ssueeai;`I shall-not employ any person in such manner as <br /> to ,become subject to Workman's. Compensation I laws of. .Call <br /> f_orniaik:!). LARENCE'S SEPTIC &'SEWER 'SERVICE <br /> Signed �, - ----- !-- = = -O 20 So. Oro Stockton, Calif. 95205 <br /> a i w er F ;, 6 ,y I <br /> B h-___-____ ' o, 09 Contra tor.'sl_ic.;�21;11111 <br /> Y Title ----=-----=_ 3 32 <br /> T .. (If other t an owner] = 4 ' �,.� ;iAl <br /> J <br /> 41 FOR`6EPA-RTN[EFI"SIE: ONLY. ► <br /> APPLICATION ACCEPTED. BY �'� k =-----------=-------=------- ---- ---------------------- DATE. . <br /> DIVISION OF LAND NUMBER------- ----- s =; DATE-' - J <br /> --------------- _. ---------------- <br /> ADDITIONAL COMMENTS_-----------a___.__ ' i <br /> -------------------- ---------------------= , . <br /> ----------- --------------- ------------------:----------------------- <br /> --- - --------------- --- <br /> a - 4e�. y` <br /> nJ '' <br /> ----- .-.� - -------- ,�-� .._ <br /> Final-lnspect•ion-bya-�-- �"•� - ---- <br /> - -------- - <br /> ---------- Rate -- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7176 3M <br />