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FOR OFFICE USE: t FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �^= <br /> (Complete in Triplicate) ° d <br /> Permit No.. / . <br /> ..................... l <br /> Date Issued......_"=`�`� • <br /> .......................... This Permit Expires 1 Year From dateI su3 ed <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 /> Cl t-Z �I--fir c,4,tiirnrfl $q Ue ' r I+`W` (075_ z.30_ Zf <br /> JOB_ ADDRESS/LOCATION.-S/(tf:..044P-4. --.EL..G�3fY1t�4.O/./ CU '.--S.f.�:�!--- `i-----...CENSUS TRACT.-------•----------------------- <br /> /� --..Phone a.J/. 6, <br /> Owner's Name.....�G�i�N6---..1.%��-?[l!�-E?�....���6^5... -- . .......:.............................----....:.. ! .. .. <br /> Address--------- 8.90 .... O.Y1ll/U.�.. �-_..., ./t.:..?r. ....... ........City..... GK7a!t/.............zip................. ...-------- <br /> Contractor's Name.. (.��'�� - <br /> ��. . <br /> License #- .....T....• ! .3....Phane.... = <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ElM tel ❑ Other------- ------------- ------------------------- <br /> Number <br /> -----------------------Number of living units:-._./.........Number of bedrooms. -....Garbage Grinder....--------Lot Size----------/o Vic? <br /> Water Supply: Public System and name--- --------------------•- . ••------....------....... ------......._ ----- --PrivateA- <br /> Character of soil to a depth of 3 feet; Sand ❑ Silt 0 Clay ❑ Peat ❑ Sandy Loam (] Clay Loam ❑ w ' <br /> Hardpan ❑ AdobeX 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ {� <br /> f <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [� Size ... . .t. X- - -•- -------- ----Liquid Depth._.--------- <br /> ♦ 5 <br /> ... . . GLr. Mater>ial. �/f/ <br /> .. -.. ' No. Compartments.----...:.Z------------ <br /> Capacity..._/aOO...-Type <br /> Distance to nearest: Well.......... � , `± `� ------foundation-----A�-"_ ....._Prop. Line----- <br /> % 4:421 <br /> [ <br /> LEACHING LINE [VT No. of-Lines--- :-Z.-.:..1......Length of each lime-------_546-"KY.....Total Length _...----/s --------------•---- <br /> D' Box...✓-.Type Filter Material_.-�-7 ---....Qe tb_Fit - ---- <br /> ter�Material---=- - ---------------------------------------- ---- <br /> �. j r / r <br /> Distance to nearest: Well-- -- ©---------------Foundation-`----- ---- --.......Property Line..-----..s--.--------- <br /> 1 , <br /> / Rack Fillet! Yes No- <br /> Depth.-.1'.0.r.-Diameter] <br /> [v]' : <br /> . -----------------Number-----------Z--------------- <br /> rr /r. <br /> Sl�rflp Water Table Depth--- -----------------••--------'-------- ................ <br /> -•......---- `Rock Size....`...` ....X..II .. =......... <br /> Distance to nearest: Well:'......__-V----'----- ....Foundation:........, .r.......Prop. Line------` ------------- `' <br /> REPAIR/ADDITION (Prev. i <br /> (Sanitation Permit#----- ----------------------- - -Rate ) <br /> 1 r -------- - ------. <br /> ---- --- - ------------- ------Septic Tank (Specify Requirements).. = <br /> Disposal <br /> Field (Specify Requirements)'---........ i ..---- ........... ---- <br /> ' 3 <br /> --------------------. . ............... .......-----------------:.-....------................................ <br /> -- - --------- <br /> =:.... <br /> (Draw existing and requi°red addition on•reverse side) <br /> I hereby certify that I have prepared this application and shat the work will be done in .accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the_San7oagvn:Locnl 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 be t to Work n's Compensation laws of California." <br /> ,. i °., <br /> Signed............. . ............. •,- - --'---"���........................------------ ------. Owner <br /> By-...... Title. + a ---------------------------- <br /> ----- <br /> (if other than owner) <br /> FOR DEPARTMENT USE'ONLY <br /> l <br /> _.-DATE . ..... <br /> APPLICATION ACCEPTED BY--------. <br /> + DIVISION OF LANq-NUMBER--::.--.—,._-------------- ..........DATE- ,------ <br /> k ADDITIONAL COMMENTS. N15t --...9�`7Q="i-.__+_-.'.:-=-�---•�-------------- --------•------ -......- <br /> -------------------- - <br /> ------ - .--... <br /> — <br /> -------------------------- - ----------- --- ------------ -- <br /> i �, ------ ----- <br /> --- ----------------------- --- Date Final Inspersion b a / f <br /> -- - - - ---------- - - <br /> EH 13 24 SAN JOAQLI CAL H TH ISTRICT ' <br />