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FOR OFFICE USE: <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT � <br /> - Permit No.X71.--3 -•� <br /> 7 - <br /> (Complete in Triplicate) <br /> ------------ ------------------- Date Issued...-�.' .� <br /> „---,_-------- ... This Permit Expires I Year From Date Issued t <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 Regulation <br /> SSQ <br /> JOB ADDRESS/LOCATION- •--yC _...--- ----- CENSUS TRACT --- ------------ <br /> Zz1 __. �$E!�2Cff- <br /> Phan <br /> e <br /> Owner's Name.-- .--.91.--_ _ 8. . <br /> S7& - -_..._... __Zip- <br /> Address_. f `S- � .._ ,..-- Z�? ---- -- .......... ......... ........City._.... r <br /> aY- - <br /> ,. 353 Phone.--.�-�_.__.. . ; <br /> Contractor's Name-... ------------- <br /> Installation <br /> al-Sr►se #_O�. T' <br /> Installation will serve, Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑; 1Olher--.7 - -L ! ,r__,_.._.._.. <br /> ___ -_ <br /> Number of living unit-!;--_:.._=Number of"bedrooms._.....-.:..Garbo e G'rmder_-- Loi-Size__-- . ....-...-. <br /> Private' <br /> Water Supply:i Public System and name__------ ------------ <br /> --- ------------------ --------- <br /> Character of soil to a depth of 3 feet: Sand ❑. Silt❑ Clay ❑ Peat El Sandy Loom ❑ Clay Loam El ^ <br /> Hardpan ❑ Adobe`s ; Fill Material If yes, type----------•----- ------ - ------ <br /> (Plot plan, showing size:oflot, location of system in relation to wells, buildings, etc, must be placed on reverse side.} <br /> NEW INSTALLATION: �(No septic tank 'or seepage pit permitted if public seweF is available wilHin 200 feet,] �I <br /> / A} <br /> _...--._Li uid De th._: <br /> PACKAGE TREATMENT [ ] SEPTIC TANK. [VY ' Size ..- _....` -- ----- --- q P <br /> ' <br /> of, ;a~ _ _ ------ � TP -----INo.dCompartments--------- ......................... <br /> -- <br /> Capacity... TYper•_--c- _. ._. Material------CProP Line-----s-- ' ---- ----- <br /> Distaneo nearest: Well....__ s ------- Foundation------J . <br /> ! <br /> r <br /> It. ...Length of each line----- "1 ----------------Total Length <br /> ...:..__� a <br /> LEACHING LINE, [�No- of Lines -t_._.�------------- <br /> Dr Box Type Filter Material..���.Q..--. Depth Filter Material------------ -------- ---------------- <br /> 1 ' <br /> Distance nearest: Well.,_,__ .0 �f" .... Foundation-- ----------- --- -------Property Line.___---------- ------ <br /> f / '`,� + - Rock Filled YesV No <br /> De th__:o�s Diameter 33 1..0 .Numberx <br /> SEEPAGE PIT [),]�� p F.... i d � �- �r �� `� .� - - <br /> i �- /S� }C. = ----------- <br /> _ Rock 5ize.__.:3- . � <br /> Water Table Depth---------- j <br /> sd Foundation------. -. ......Prop. Line-----'-� --: <br /> i Disfance�to nearest: Well.__.__._.--�---- --- - � - <br /> *'s <br /> REPAIR/ADDITION (Prev. Sanitation Permit#..------------------------- <br /> --------- . •--- -- -- --- �...............] , <br /> i Septic Tank i(Specify Req irements) ,.. --�:----�-------� - - . <br /> / j r i , _j.., ----------- <br /> I{S[E` Disposal Field (Specify-Requirements)..------------------- -•- --------------•-.,---•---_= --------•-----..:--..4.------ - <br /> •. <br /> ____________________________ <br /> ............................ ... ._.-___-__-_-----.-.._ .___ <br /> .. - - - <br /> , <br /> l [ - .. -------------------•------------ 5 _ <br /> ,f� <br /> it r* , <br /> `-' (Draw existing and required addition on reverse side) ; 4 <br /> I hereby certify that I,,have prepared Phis application nd that the work will beiinne ni accordance with San Joaquin County <br /> Ordinances;`State Laws,; and Rules ' aand Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> E signature certifiias the f0lowirig: *. <br /> -. <br /> "I certify that in the pei'Formance of the wortc•for•wfhich this permit is issued, I shall not employ,nny�person in such manner as <br /> F r- A <br /> to become t.suiiject o ;Warkrfian's Compensation -I"aws�of-..California." i <br /> d * w <br /> nqr <br /> Signed.........-__.�. ._- . 1 <br /> --- <br /> [ B -- - `'®4�- Title- <br /> iy_-------------- <br /> (If other than owner) `•. <br /> +t F R DEPA T NT USE ONLY y <br /> APPLICATION ACCEPTED BY-------- - -- ---- --- --------- -`-°"`-' <br /> 1'U!. ............. ........ ...... DATE . - ---. <br /> DATE:-- --- ---- -_. .. _. __....._.. --- ---- <br /> DIVISION OF LAND NUMBER...- -- ------ ---- ------- . ----- --- ------- .--- <br /> --- ------ --------- . . . <br /> ADDITIONAL COMMENTS.- ---- - _-- -- -------------•----- ------------;­._­-------- <br /> ............... ------_-_._...- _ �- �- _..-..--_._.._-k______--__.___-..______-..__--___-________.....- __-_._____ ____---__-_.----. -._-- --- <br /> �f( .. - F� ' - ------- -- ---- -------- --------- -------- -------- ------- ------- ---- <br /> Y <br /> ________________ /�/y- ..._-._ <br /> ..-- -----••------- ------------------------- --�- - -.._...__-_.. _ - _ _ _ _ ate -- - - � - <br /> Final Inspection b <br /> F S 2j41. <br /> 7REV: �I6�M <br /> EH 13 sa SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r <br />