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k <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> ` APPLICATION FOR SANITATION PERMIT <br /> ---------•----•----------------- - -- -- Permit No..7 `..� � <br /> k {Complete in Triplicate} ---. <br /> Date <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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> E JOB ADDRESS/LOCATION.......... .7`5 SP Y'q.i. ._ _.... .�.)Snl.............^-- CENSUS TRACT. - ....... <br /> F ! <br /> Owner's Name. (� ................Phone...��G- <br /> Address------ 3 7. �-- rl �"� ��s-- -----. ....... ......City------------. --•- Zip - ;.. <br /> . -------------- ------- - Com rcis Trailer ----- ......Phone--- -- '------------ ----- ------ <br /> Installation <br /> �. .. License #---------------------- - <br /> Installation will serve: Residence ❑ Apartment Hous ❑ ❑ Court ❑ <br /> Motel ❑ Other-... <br /> ', 0 l�c.r s.--=--- <br /> Number of living units :_-_..�.........Number of bedrooms_�-'::�...-.Garbage Grinder------------Lot Size.........,. ..... .. . - <br /> �` <br /> Water Supply: Public System and name.... =-`... Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt ElElClay Peat E] Sandy Loam ❑ Clay Loam <br /> Hardpan E] Adobe ❑.Fill Material.. .:- _.If yes, type----.-----------------.------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.). <br /> f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> ' PACKAGE TREATMENT [ ] SEPTIC TANK Size....,.- .. .a-� - --------- Liquid Depth...�--.�---------- <br /> L. <br /> Capacity:./�.0Q--------Type- T4s- Material..C'_dAe_J:`.r". '_.:No. Compartments------ Z•....................� <br /> CA <br /> Distance to nearest: Well_:-...�X9Q_f.r------------------Foundation------�`..7 .....- ----- Prop. Line, 0./lr---- <br /> i � r <br /> LEACHING LINE [ ] No. of Lines.........- Q <br /> Lengib of each Zine...........�Q.......-..--Total Length ...... --------- ----------- <br /> .... ... <br /> Q' Box.............Type Filter Material.S.007r.G/ .. epth Filter Material-------.---I-B.. ----•••-- -- ---.... ------•--s <br /> 1 'I / <br /> Distance•to nearest: Well..=...> 1Q©.y......Foundation--_ � ,4.. <br /> ... . -.---...Property Line--------- 5-------------- <br /> F Y <br /> T [ ] Depth....../. --r.. ;,Number-----------/------------------- Rock Filled Yes E] No [:1M r <br /> Water Table Depth----- --------•- DQE ------_-----------Rock Size.....L <br /> 744 .Foundation....._- `t0----.... Pro ...- ----- -- <br /> . - --._- <br /> Distance to nearest: Well---------------�--��-------...--------�- '� - p• Line <br /> _,.> <br /> (Prev. Sanitation Permit#_................... ................Date.........:. -- --­------------- <br /> Septic <br /> _----- --------•Septic Tank (Specify Requirements)------ - ----- --- I ............. <br /> .............. <br /> Disposal Field.(Specify Requirements)'-.-.................. -•-- - <br /> P <br /> ii s - <br /> ................................... <br /> (Draw existing and required addition on reverse side) <br /> I I hereby certify that 1 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 /> signature certifies the following: €�' <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become s ct to Wor 'g Co ensation laws of California." <br /> 7 <br /> iSigned.......... s ......... ...... . - ------- --Owner <br /> Ii ....Title..--•-----------•--------BY--- .--------- ------------- ---------------------- -------- <br /> (if other than owner) <br /> FORADEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY............... DATE <br /> DIVISION OF LAND NUMBER ------_--... --- --- .--.DATE----- ------------- ------------- ------ -- - <br /> y _ .� T ...... _ <br /> ADDITIONAL COMMENTS _7--~- �..----- _ =..........— -- ....__-.... ,. <br /> 1 <br /> . <br /> . :......-.........-..-.......... .. .. ... .."]..-.- <br /> ... <br /> .... ..___.......... <br /> ............ <br /> .......................................................................................... .............. ...... ............ _ . <br /> ...... ..._......-.--........................I.......... —...... .................. ............... c ----------------------- -- ---------- <br /> ------------_Date-- <br /> Final, - ------- -............... .............. ........ -------------------------------------------- <br /> ------------------- -....._... <br /> InsAecjon b <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FGS 21677 REV, 7/76 3N <br />