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7,� <br /> FOR OFFICE-USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> y <br /> (Complete in Triplicate) Permit No.._____________----- <br /> __ <br /> - <br /> --------------- <br /> Date Issued-.- - ---(� � <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 /> = --.CENSUS TRACT--------------------------------- <br /> ------------------- <br /> " <br /> JOB ADDRESS/LOCATION_ " <br /> } 7 ---- -- --- . <br /> Owner's Name_.. = <br /> s r, hone <br /> t . . <br /> .. �- p -------------------------- <br /> ----- <br /> -- -- ------ <br /> �LJCity :Z� t <br /> Address � -- .- a,�.`� _ ----. - -- ;- ` <br /> - ----- ---- - <br /> f ��.. ..r. �Jr one_. --- - ------------ <br /> of <br /> - -- <br /> Contractor's Npme_ '�-- Y— -- License #_ ZB� Ph € <br /> F - - � r . <br /> :�. . _ <br /> f Instollation will�se�rve: 3 4. Residence [;l Apartment House.❑ Corrimercial ❑ Trailer Court; ❑ <br /> ' Motel .Other <br /> Number of livin units:___ Number ; v4 ; F <br /> +� 9 $ of.bedrooms -�_;___Garbage Grinder-.------�-.Lot:Size - �-���` r- <br /> Water Su i Public System and°name--------- ---- -------.--------- ------------------ ----------------- - P to <br /> i -- riva <br /> Character of soil to a depth of 3 feet: ' Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> r # Hardpan ❑ ; Ado be'1� Fill Materia L..._.__._.--If yes, type-------------------------------- <br /> r <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,,etc. must be placed on reverse side.) ' C <br /> .I•..---^ -. 1 <br /> TREATMENT"' SEPTIC TANK"-seepage, � p permitted i#ted if public sewer is available within 200 feet,] < -/ a <br /> NEW INSTALLATION: .;(No;septic tank y . it er � / / } <br /> f pC <br /> I PACKAGE T �..�.--s F ,�s, �- Q =�� --Liquid Depth.------ ---------------- <br /> No. <br /> --~------- - <br /> i <br /> Capacity_���+ :Type - -- �:�--"- Material � No. Compartments------ � { <br /> -----------� <br /> . ._. Distance.to_n_earest:,lNeLL, ----.:., �--f= __ .•.--------:--Foundaion"_ '--�=- ----- Prop. Line_,=_- <br /> I ` `T per" "Total Length ------------------------ <br /> LEACHING LINE " [vf No. of Lines ___ _' �J` .Length of Veach Tina . - ! <br /> D' Box.__. :Type Filter Material S_�Z -Depth Filter Material ---ly'- --- ---- f - <br /> ` .._.. <br /> •. <br /> ¢ f t --- - <br /> Oistonce r __ uraton Propey Line <br /> SEEPAGE PIT [ Depth____Za___.__Diameter_ .___ ---_Number_.___--_____.-__-y___.--_--- „ Rock Filled Yes- No:❑ <br /> $ Rock Size -J/ ---------- <br /> --- <br /> VIlater Table Depth---------------�i_�_� -------- .3 <br /> � ` } --------Foundations Prop.Line - <br /> f ------ ---- <br /> �., <br /> Distance to nearest:Weil_..-- --��-�--- -�--- -------�- --- . -_Prop. <br /> I REPAIR/ADDITION (Prev. Sanitation Permit#--r------- -=- -- = Date-.----------r___------------------ ----- <br /> )� <br /> Septic Tank (Specify Requirements]_-------------- -------------------- ------------- ---------------------------------- ---------------------------------- --- <br /> Disposal Field (Specify Requirements)-------- ----------- ----------------- - ------ ------'--------------_---------------- ---------- <br /> 1 <br /> --------------------------------------------------------- <br /> � 2 <br /> Y - _ __ ___________________________________ ______________ _ <br /> _---.__ __ _ <br /> __ __.----- <br /> --------------------------------------------- <br /> -________ ___ <br /> 1 _.____----_____________________ <br /> -------------------------------_----------------------------------____---------------------------------------------------_------- <br /> ___________ ` <br /> : (Draw existing and required addition on reverse side) <br /> I hereby certify that I helve 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 �th work for-which this permit is issued, 1 shall �nof employ any person in such manner as <br /> jecf to Workman' .Eomiensation laws of California." <br /> to become sub' <br /> Signed------- --------------- --------- ----- -- ---- -- ----- Owner �} <br /> -- ---- --- <br /> . <br /> --- --Title-- P <br /> " (Lf other than owner) t <br /> FOR'DEPARTMENT 115E ONLY <br /> - ----- ----------- <br /> APPLICATION ACCEPTED BY:.____. ___-_...- _ _-___DATE - �� <br /> DIVISIONOF LAND NUMBER --------------------------- -------------------------- --------------------- DATE.------------------ ------------ --------------- <br /> ----------- <br /> ADDITIONALCOMMENTS---- --------- ----- ---------=--------->------------------------------------------------------------ <br /> ---------- <br /> - - ------------------------------------ -- <br /> ------------------------------- <br /> --------------------------------------------------- ------ <br /> D t <br /> Final Inspection lay::__ a e --- _-- <br /> ------ - - -_: <br /> Er1 13 24 SAN JOAQUIN LO AL HEALTH DISTRICT F&S 21677 REV. 7/76 U <br />