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F�r`OFFICE USE: FOR OFFICE USE: <br /> ;,;� ; APPLICATION FOR SANITATION PERMIT <br /> ---- ------- ------------- - Permit <br /> " - ------------------ -------- (Complete in Triplicate} <br /> -d,. rF t <br /> ----------------------------------------------- - yyz Date Issued_Y:�-1Q.:,7. <br /> _----------------------- �______._ This Permit Expires I Year From Date Issued <br /> I •E <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 <br /> I _ M� -----------------Regu <br /> laytions: — <br /> ON - CEN5L5 TRACT <br /> JOB ADDR=SS/LOC <br /> ne ---- <br /> ---------- <br /> - ------ <br /> Owner's Name_. r - ho <br /> E <br /> F / ,. <br /> Address_/�i. l Q ------- ---- - - <br /> ------ <br /> C ty Ph Zip � �- <br /> g <br /> Contractor's Name = -License #_ A one . <br /> Installation will serve: Residence artment House ❑ Commercial ❑ .Trailer Court}❑ <br /> -- - ` <br /> Motel ❑ - Other-=---- --=---- ----=---=------------------- <br /> ' Number of living units:----/--I ------Number of bedrooms...1P9--Garbage Grinder--------.-,..Lot Size... ........... :7!7-=-•---- <br /> Water Supply: Public System'and; :name: ..'----- --- ...-_--------- i__ - := = = _ Private 5 <br /> f e ��- <br /> f • Y E _ ❑ e- y Loam ❑ Clay Loam ❑ <br /> Character of soil to a depthHardpan❑ �.Adob�[ Fil�aterpal__...;__:P!f yes, type- <br /> yes, <br /> i <br /> 1w.. <br /> (Plot plan, showing size of lot, location of system in relation to'wells, buildings 'etc. must be placed on reverse side.) ° r <br /> ' NEW INSTALLATION- '(No septic tank :or seepage pit permitted if public sewer is available within 200 feet,) r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------------------------- -------�t---- 'Liquid Depth---------"------:---------- <br /> Capacity-- ------Type-----=-----------------Material----------------- --------No: Compartments =. <br /> l '.Distance"`to riearest `Well-�------- --. --_ 1Foundation- ----------- ---=----Prop. Line,-------------------- <br /> r � <br /> LEACHING LINE, [ ] NG) of Lines..:_--- '-: ---_.-'---,-, ngth of each line----------------------------.-,Total Length._,:----r---------_------•-------------- <br /> D' <br /> " � -- Diameter <br /> ....De t_h. Filter Material,-�-, <br /> -"~---------- ------------------------------------------ <br /> ---------- ------"Box-- --- Type Filter Material- F..- <br /> pistance to nearest: We _______________ ------------Foundation--------------- Property Line--=-------------------------------- <br /> SEEPAGE PIT Depth - -------- -- -- -Number__<=- --------------- ---------+ Rock Filled Yes:❑ No'❑ <br /> . . Ro <br /> Water Table Depth- =------; ------ ----- -- - <br /> to nearest: Well -------------------- <br /> .. k.S <br /> " - <br /> --���-._ •. -------------------------------- <br /> _ _ �,� € _ _ Foundation--=----- ----- ---.Prop. Line------- <br /> t-4 <br /> ----------- - -----� <br /> t . <br /> .. .,_� -:-, ..• Date , <br /> REPAIR/ADDITION (Prev. Sanitation Permit#- -- ------------------------=-- <br /> I <br /> Septic Tank (Specify Requirements) ---"----==- --- � ---- .. ---- ---��p--�-�---'�---�- -------------- - --------- ----�s <br /> Disposal Field (Speci .31 <br /> fy Requ�"irements)_ <br /> } 1' i --- . -` <br /> �~ ----------------------- <br /> ----------- <br /> -- -. <br /> 4 . . ___________ ------------- <br /> (Draw existing and required addition on reverse side) <br /> hereby"certify that"I have prepared-this application and that*the work will "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 /> 0, E <br /> signature certifies the following: <br /> N certify that in,-the perfo0m66ce•6f"the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become AvbUct to Workman's fampensaticm laws of California."., a„ <br /> Signed - �. = t <br /> - - - - - Owner <br /> r j p <br /> ------------ Title ---------------------------------------------------------� .. <br /> i {lf of er than owner) <br /> I I�� FOR DEPARTME T USE ONLY <br /> „E <br /> BATE . =�_7�.__.---- '---=----------- <br /> APPLICATION ACCEPTED - --------------,-•--------------------------- -- ---- <br /> DIVISION OF LAND NUMBER ------ ------ -------- -------- -- ------- --------------DATE.------------------- :----------- -------- <br /> -----------------------"--------- -- --------------= • ---- <br /> ----------- <br /> ADDITIONAL COMMENTS.��.,lv���----��f.�- -�--��- ._.�?�cC----------- - ---••--- <br /> -•------ ------------------- ---- -- --------- -------------- ----------------- - <br /> - - <br /> I ---------------------------------- --- -----------.--------- <br /> --- -- ---- <br /> dh ---- --"------ <br /> -- ------ - -- ----- -- -------:- - - -- - ----- --- <br /> Fina[ Ins ection b '- '"'- Date _rJ <br /> p Y ` - <br /> EH 13 24 SAN OAQUIN LOCAL HEALTH DISTRICTIL <br /> gas 2i6n eEv. <br /> x <br />