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FOR `OFFICE USE: FOR OFFICE USE: ; <br /> APPLICATION FOR SANITATION PERMIT <br /> ............I •........................ .... {Complete Permit No....l...Cl.:•-J�..7..r <br /> in Triplicate} <br /> ..........lp <br /> -•-•............ ... .................. . <br /> Date Issued....... 7� <br /> ......................................................... This Permit Expires 1 Year From Date Issued <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 Js made in coinplionce with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA.,l�!4��TIION.��.�. .Jr..�.....-. �...� ------ -------- ------- - <br /> ---.CENSUS TRACT............................ ... <br /> Owner's Name.... ------------- ............. - --------------Phone..... - . ....... <br /> 73 J� dT ....__..... _ ...Zi ----- <br /> Address. .. p <br /> .2��._ ....��"t?.�2!G- `j ,f --- -...City....---- <br /> Contractor's Name------T ..... 0. ...License #----------------------- -- -Phone_.----:._..-.. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other....l ............f---------- <br /> Number of living units:------ .......Number of bedrooms._-.........Garbage Grinder------------Lot Size_......�6� _. `�`S <br /> Water Supply: Public System and name.......... ...... .... -----------•----------------•----- ..- --------- ------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam <br /> Hardpan Adobe ❑ Fill Material.. .___ ..If yes, type... ......... - ........ <br /> [Plot plan, showing size of lot, location-of-systemYin relat:on to,wells, buildings, etcmust-be placed on reverse side.] <br /> NEW INSTAL;ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size - <br /> a/ Liquid Depth............. <br /> A /Z ..__� -YMatexial-- - ---- N - <br /> O. Compartments.-..----:-_--------- <br /> Capacity-'RC1. pe- �` <br /> Distance io nearest: Well............. .. ..... . ..Foundation.. ^.._ . Prop. Line <br /> LEACHING LINE I]Q No. of Lines .../--------------------Length o eac ine.. . i..= Total Length .. I=- --_--------- ------------- <br /> in - - - <br /> '11 <br /> + � i<j����I AL 1"t // -� <br /> 'D' Sox__�... ..Type Filter Material...-. _.X--_.X—Inepth Filter Material.-.--...--l-- -----------------•---- �/ <br /> Distance ta.neares#:,WeIL._IQ.U..-�� Number Foundation----:IO..---�......Property Line- .��.------------- - - <br />!4 <br /> Rock Filled Yes ❑ No ❑P <br /> SPf'1'IT /K] Depth._ -.- _._..t_Diameter..--. __ <br /> u �N P Water Table D the _.. '-. ....�, --- ,-Rock Size. - ---------------- 14 <br /> � la / � ��. -_- Fo'undation.,� Prop. Lin --- <br /> Dis a c t nearest?Welf- _ <br /> REPAlR/ADDITION {Prev. ?ani#ati�n-rrmit*# .-..................- ...... ........Date------------ -------- --- --- ------ <br /> Septic Tank (Specify Requirements)---- _..- --------------- ........... -/-------/........../- -•------------------ ------- ..... <br /> Disposal Field (Specify Requirements]------....... ... �----------� �zo...• ' <br /> -•------------------ • -------- ---- _--- == <br /> t _----� <br /> {Draw existing and required addition on reverse side) * <br /> I hereby certify that I have prepared this application and thaf the work will be done in accordance with San Joaquin County <br /> s Ordinances, State' Laws, and Rules and Regulations of theti Sdn 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 is issued,�ILLshaE1 not employ any person in such manner as <br /> to become subject to Workman's Compensation'laws of. California."Signed y <br /> w <br /> R <br /> ' -� . <br /> - n <br /> By .....Titl ..... �..._..... <br /> t (If other than owner)j f� <br /> FOR DEPAR ENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -- - ..... - <br /> DATE r �............ . <br /> DIVISION OF LAND NUMBER --------... . - ----.--- DATE. <br /> ADDITIONAL COMMENTS...---- -- ------ .{ .....-..._ <br /> . .....----- <br /> i ------------- ---------- :..... ------------- ------------------------------ -,-- ----- -----...---- -------- ------- . ... . -- .-.... <br /> l ] <br /> .... •-- ------------------------------------- ----- -------- <br /> --------•.......... .......... ... -- <br /> l. to --- vg . .. <br /> Final Inspection b Da v�� sM <br /> y:.... <br /> EH 13 24 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT F8s 2itr77 REV. 7 7a <br />