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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> {Complete in Triplicate} Permit No,7$'— _PL. <br /> --------------------------------------------------------- <br /> Date Issued .-78' <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 /> al j-� -�. - -- c�(�------ CENSUS TRACT_ <br /> JOB ADDRESS/LOCCAATIO/N(�____-: ..:__- �- ---- ----- -- <br /> /� <br /> } '?.' �_� ----- --r----------� y------ --- -------Phone�� <br /> Owner's Name--- s_.. <br /> ✓' l/ 'fit - <br /> Address------- -- ----------- ` '7'�`=`f' � --�- - --------------------------- <br /> -- -- --�r- - - City- Zip------------------------- - � <br /> Contractor's No ------------.._License #--- 57 /-----Phone_ -- - -- <br /> Installation will serve: Residence U5,- Apart-ment House.❑ Commercial [] Trailer Court ED I <br /> Motel dOther- -----:-------------------- ----`- , <br /> Number of living units:-------- of,bedroom:s_. _'2�-__Garbeige Grinder------------Lot Size----- ------- e__.=,__sy__._-.---- <br /> ----------- 1 - ----Private <br /> CharacterPof soil to a depth of 3 feet: Sand � t..---:-- - ---------�---�---- --- - ----------- - -�- - �'�►, <br /> Water Supply: Public System' <br /> stem and name____ <br /> _ p Silt Clay Peat Sand Loam-�Clay Loam ❑ <br /> .. . nd ❑ . ❑ � Y ❑ ❑ Y <br /> Hardpan ❑ Adobe❑ Fik11 Materidl....__s_:: If yes;type--_ .__,.___..'_..___ 1 <br /> k � <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I, <br /> NEW INSTALLATION: No Ise tic tank'or see 1 r <br /> ( p s page ,pit permitted if public sewer is available within 200 feet,) CIO A <br /> PACKAGE TREATMENT SEPTIC�TANK [4— <br /> [� �_/._,._- -- �Ze � --- - / ----- Depth <br /> eP h.__. ---------- <br /> Capacity.-/40.0 <br /> --------- <br /> Ca acit ._/4w--- TYPe___' + Material-�C �---4-----�No. Compartments __t�-------------- ------- <br /> Distance to nearest.,Well.,.._l _.-..... _ ________Foundation_ Q Prop. Line-------------- - i <br /> ----------- <br /> LEACHING LINE [L}� No. of Lines---r"�- --------._____..Len th o�f'each line ----------------------- 4p�}� j <br /> c <br /> Length Total Length. _ <br /> l D' Box_J _ Type Filter Material,f_ %r���� Depth Filter Material__"-__ `_�.---------------------------------------------------- <br /> /IL . <br /> I <br /> Distances to nearest: Well----,/, _ .___.Fovnclation._. , Property Line._._ �� w <br /> -- -- . .1. <br /> _ -- _ , <br /> SEEPAGE PIT [' Depth__ -JD`i6meter__,�✓_`___ _Number----------- Rock Filled Yes E�-- No ❑ <br /> WaterkTable Depth f---'- -------r--------------------------------Rock Size.- -/----- d' 1L'- <br /> r <br /> Distancelto nearest: We1L___/_&S____________________:_____Foundation----------------.---------Prop. Line -------------------------- <br /> DREPAIR/ADDITION Prev.lSanitation Perrh� #----------�`- --�=-----------------------------Date-. -- ---�-------_------,------------} . <br /> Septic Tank (Specify Requirements) 't =` == E l----------------------- ------------------- ------------------------------- -----------I--- ------- --- --------- <br /> Disposal Field [Specify Requirements),-JA-------------- --- -------------- ------ ------------------------------------------------------------------------------- --------------------- <br /> ----------- <br /> ----------------------------.---------.----------------------- ff _ <br /> (Dr w existing and required addition on reverse side) <br /> I hereby certify that-I have prepared this lapplication 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 r <br /> signature certifies the following: <br /> "I certify that in the performance 'of the work for which this permit is issued, 1 shall not employ any person in such manner , <br /> to become subject to Workma Compensation laws of California." t <br /> Signed ----- - ----- ---------------------Owner k <br /> _. . . <br /> By-------- ----- - r ^ �C-`- <br /> -- Title- /1lr ---------�--- <br /> �� ]If other than owner) <br /> FOR DEPARTMENT USE ONLY: <br /> APPLICATION ACCEPTED BYQATE. <br /> ---------------------- 7­-Z2--;7-F_ <br /> ------------------------------------------ ---- ---- ------------ -------- <br /> DIVISION OF LANA NUMBER---- ---- --- - ------ QATE--------- -- ---- ---- ------------��- -- <br /> ADDITIONAL COMMENTS <br /> ---------- - -------------------- <br /> -------- ----------- <br /> ----- <br /> /------ <br /> Final Inspection by_ .- Date.-_- -.� --J-l <br /> ,/ ______ _ <br /> _ <br /> EH 13 24 SAN JOAQUIN (OCAL HEALTH DISTRICT Fos 21677 REV, 71763M <br />