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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - - <br /> -------------------- <br /> _` Permit No---------------------- ' <br /> (Complete in Triplicate) <br /> !. 1 - 7` -s <br /> i Date Issued--_.---_=_.-------------------- <br /> -------------------------------------- -- This Permit Expires 1 Year From Date Issued <br /> y <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 /> �­- <br /> JOByADDRESS/L•O-AION� - - -_CENSUS TRACT. <br /> z.._ <br /> r ho <br /> Owner's Name: -- = F --: ------------- ------- --:...----------------- + <br /> `P ----- ------------------- <br /> a °I <br /> ..t_ . � ` t City Zip <br /> Address---- <br /> Contracto 's NamelW i - , i i�License # <br /> lnstallation will serve:_ Re"sidence Apartment House.F] Commercial ❑ ;Trailer Court' ❑ > <br /> .., <br /> � - Motel ❑ Other-= _ -='-'------'-_-- '... <br /> Number of living units:, - __ _Number�of:b .drooms _%.tom Garboge Grinder �-:'LLott Size--- <br /> Water Supply: Public stem,andname___. -- .� -----L � `- r<` Privates <br /> Character of soil to a depth of 3_ feet: Sand Q Silt ❑ Clay ❑ : Peat LJ Sady Loam ❑..r Clay Loam ❑ c f <br /> Hardpan ❑ AciobE _ Fill'Materi�l . -- ------If yes, type------------------ ------ <br /> {Plot plan, showing size of lot, Iota ion.of system inaelbtion to,wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: (Ndj septic tankor seepage pit per'rilitted if public sewer is available within 200 feetA s <br /> PACKAGE TREATMENT [ ] SEPTIC TA'NK <br /> s "* <br /> Sizer.- atef�rial:�D No. -- ---. Liquid De ___�------ <br /> - ---------- <br /> Compartments-- ---------------------- <br /> -- - <br /> f!� <br /> Distancefto nearest.: WeLI- � � 'f' �� �otah Len th-_p�.� ,� --------- <br /> INE No. of Lines- ------ . . g . g i <br /> -------- <br /> LEACHING L Foundation Pro Line <br /> L r ' Len th f eat lms.-- ---_ -- ----- / <br /> .'D' Box__:_ a Filter Material-- ----De th Filter Material -1.��� ----•- ---------------- <br /> ---------- <br /> - -- <br /> } <br /> P <br /> k Distance to nearest: Well f L'-------{-Foundation--__-�47_ ___:.. .Pro er Line-_-�--_- -- ---.- k- <br /> SEEPAGE PIT Det } _ <br /> p ♦ - Diameter_ ---- ---NO r. 1�---- :-- Rock Filled 'Yes f No <br /> r -- <br /> Water'Table Dept1�_ --g . ;- `Rock 5ize� -- ----- <br /> - <br /> ! ' .:_.Pro Line -�~ -/----- -. <br /> Distance to nearest: -.- �!_ --.Foundation- �__.-- p. <br /> Well ��-----�-�-- <br /> AIR/ADDITION (Prev. Sanitation Permit-----=--------------'---- - -j- _- ---Date__-_- __ -------- <br /> RE. -- <br /> `' I - ---- ---=---------------- <br /> -------=° <br /> Septic Tank (Specify Requirements)---- _ - ; <br /> - 1 • \. <br /> Disposal Field(Specify Requiremen#s)----- �.'---a-------- --=----------------------------------------- ----------- ------`- S ----:------------------------------------------------ <br /> i <br /> --=- --,------------- ---------- ----- i <br /> zl, 1 r--- __ _ _ ------------------ __-___ __________ ____ ______________,------------------ <br /> ----------- <br /> _ _-___. _ <br /> -_-_•_ _ _ ____________ <br /> --------.___ <br /> ----------------- <br /> _____-________________________ ------------------------------------------------------- <br /> 1. <br /> __.________-__---___.___-___.___ __ __.____.__.--__-________ _`_ ----____________ __-_------,---_______- ...---- ___ __ ----------- __-______-_`____- <br /> _ (Drdfw-existing and required additioyri reverse side) ` 1 <br /> hereby certify that I have prepared this application-and that1the 'work wiles be done in accordance with San Joaquin CountyOrdinances, State Laws; and Rules,and Regulations of the, San Joaquin,Local Health District. Home owner or licensed agents <br /> sig nlatul certifies the following: <br /> F� which this permit is issued, I'shall not employ any person in'such manner-as <br /> I certify that in the performance of the work far p _ <br /> to become.:subject to .Workman's Compensation laws. of California." r rMA.RENCE'S SEPTIC & 'SEWER SERVICE <br /> Signed___-- - ---- ----------- --- ---'-_--:-'- �_ '------ Owners 263 So. Oro Stocfttnh, Calif. 95205y� 11 <br /> *u I liCnCiOi_? iL._#Z6717Z---- <br /> ,'�'�L <br /> �M• - Title_ ? Fh 463-u20 <br /> 9 Cur <br /> r (If other thano�ier ,a <br /> F DEPARTMENT SE ONLY " v <br /> loll <br /> - - -- <br /> APPLICATION ACCEPTED BY_.- -- -- -- ' -,- - DATE~_ :Zi2-- - <br /> DIVISION OF LAND NUMBER a �^ -------- ----------=-- DATE - <br /> 3 <br /> ADDITIONA COMMENTS- o d!----. - = ----------- <br /> /� �— <br /> ! r .__ _____'F____________________________________------------------------------------------------- <br /> ----------- <br /> s _._-_ _. _________ ______ _-- _ - � - <br /> _______ _______ - -_ _ .• <br /> --- _ <br /> ______- ------------------------------ <br /> ____.- _ ____ _. _.___ J <br /> Final Inspection by:__-r- <br /> -ff- <br /> .� �--- <br /> rti _-. <br /> EH 13 sa �- SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21577 REV.. 7176 3M <br />