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d FCR OFFICE/USt: FOR OFFICE USE: , <br /> > i --''WiPPLICATION'FOR SANITATION PERMIT <br /> Y F (complete in"Triplicate) Permit No,_7_�_-�F7'" <br /> ----- --'- -/' <br /> Date Issued..-_-/__._'_.__ <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Ar <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 /> JOB.ADDRESS/LOCAT ION-----I _/_° US TRACT <br /> Owner's Name--- --- -- - j ''- [ - -- - -- - ---------- -- - -- --:---- ----- =.- --•----- <br /> -,:-_.� --------- -----=------'--------------- ----t s <br /> . --_-..Phone <br /> o-n--e--- <br /> -�----�---S-- <br /> Address/47�2 - ' Ci Z' <br /> S Contractor's Name_- _`� --------------- ---.- License #_rP.7/ 3 <br /> Ph <br /> Installation.will serve: Residence�?l Apartment House.D Commercial ❑ Trailer Court ❑ <br /> s -Motel ❑ Other _.>. " - a, 4- <br /> ---------- ,.f <br /> Number of_.living units:__ . Nurriber..of.kiedrooms' Garbage Grinder Lot Size_.. <br /> Y _ _ ____ ___ _________ <br /> F f <br /> Wciter Supply. Public System and name__ t <br /> er of soli to a depth of 3 feet• :-- _- - `- _-- <br /> - r �I s -- <br /> Priva e ' <br /> p ❑ L ❑ F❑] ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hard an AdobE- Fill Materia <br /> Characte { p Sand Silt.�i Clay 1_.. -''. If yes, type ._y --_---- # <br /> k E <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:' ' iNo'septic''tank or seepage pit permitted if� blit sewer is availa' 61e within 200 feei,) _i <br /> PACKAGE TREATMENT [ ] 'SEPTIC TANK Q - 'Size----------- <br /> cap <br /> �: Depth. <br /> Ca acct '/ 0�.. <br /> i <br /> �- _.Mate-rial__/� . r_No. Compartments ............. <br /> P. Y 'TYPQV% C :U1 .� p vZ. ` <br /> Distance to�I ; `-+• � �— i � <br /> J nearest: Well.-... _Dt:�..- _ Foundation_-. P__._: Pro. Line <br /> = •� ------- P S <br /> IN'fi- / T <br /> LEACHING'LINE ._-___ ------- -------Length of each line.- -S__ -15. . ==.Total Len th.:_.__!__I_D- <br /> [ No. Lines- 9 J <br /> D' Box__°d Type Filter Material<�`�4 '_Depth Filter Materia!_."__. __1__._____________________________�_r._.__.:_OQ <br /> Distance to inearest: Well_: ----------------- Fbundation____. -- ---------------_ Property Line' _ !_ <br /> SEEPAGE PIT "De th ,R-�". Diameter_... _ sy ®' <br /> P :--'-- _.. _----.Number .- o7-- _---__ -------- Rock Filled Yes No <br /> Water Table ,! <br /> Rock Size__ _ .___ ` h <br /> Distance to.neaeesh: WeI ;� Q.� - ] 9 c3 J r <br /> P <br /> Foundation--:- = '.-.Prop, Line , - <br /> REPAIR/ADDITIONPrev. Sonitatibn- i <br /> -Permit#-: � ---- =- --Date ---- - T', <br /> - - <br /> Septic Tank (SpecifyRequirements)--21F­--­' = o- <br /> I :_ - -------------- __------- <br /> Disposal Field (Specify Requirements)----------- ------- ----------------------------------- ------- -'S - -- ----- --- -- ----------------------------I----------- ----- <br /> t 1 <br /> ____-------------_______ _____________________________________________i_.._-_________------------------------- t <br /> ------------------ <br /> ----------------------- --------- a_-_____ - --------------__ �. ---.---------.--------.--------------- ___.__. _ <br /> f � <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 Son-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 slslued,•!shallnot employ any person in such manner as <br /> to becom object to Workman Compensation laws of California." _. :. . .. , <br /> r <br /> - OwnerSigned. ----------- <br /> ------------------------------------ <br /> By- <br /> - <br /> BY -- Title---- <br /> ----fi .---='-----=--------------------------- -- -'-- <br /> l <br /> ! '(If other than owner) <br /> 'FOR'DEPARTMENT USE ONLY' <br /> r <br /> APPLICATION ACCEPTED. BY-.'---. -- -------------------------------------------- DATE ? - <br /> DIVISION OF LAND NUMBER..---------- <br /> ----------------- -: --------- --.DATE = '- -------- <br /> ADI IONAL COMMENT -- ----------- - ----'-- '--- ------ ---- - - - -------------------------------------------------------------=--------` <br /> --------- ----------------- ---. .. --------------------------' - _ _ <br /> Final Inspection by.---. - ------------------------=---------------------------------- Date- _ -- _----------- <br /> EH 13 24 -' SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV.7/76 3m <br />