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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No;7. .._- <br /> Date Issue ....-. . <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 /> JOB ADDRESS/LOCATION. ...... _j.-.._ rt1- _r�, •-----.----- 1+ �.1?...<:7;(�Q.......CENSUS TRACT-------------------------------- t <br /> Owner's Name. 1►'. ...... Phone.... ... <br /> Address..--70.1......2� fi.G� ------ ev C-A......C�N^ City----- -------- ----- <br /> -- ------- Zip------------ - --- ---`------ <br /> Contractor's Name..- O._� (--.-..� .f�.-•- -�-�5 -- - ------- --------License #3-3-91.3 .�.... . Phone. ,�_7.--y�-y_y. <br /> Installation will swvd: ]ResidenceApartment House ❑ -Commercial C] Trailer Court ❑ <br /> j <br /> tel ❑ Other- ---- ------------------ <br /> Number of living units:-.-._.L_-------Number of bedrooms-_-3-....Garbage Grinder. e.S_.Lot Size----- ................... <br /> Water Supply: Public System and name-----------------. ...... -------- ...................._ ---------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand [Silt❑ Clay ❑ Peat ❑ Sandy Loam 0 Clay loam ❑ <br /> Hardpan ❑ 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 reve-rse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { } SEPTIC TANK { ] Size... -------------------- _---._.___--_-_Liquid Depth.__:___...__- .---.. <br /> Capacity.`1- --------Type----- ...... --.... Material-- - ---------------------No. Compartments-- •-------._..... <br /> Distance to`nearest: Well.............................. ............Foundation_---- --- --- --.Prop. Line........................... <br /> LEACHING LINE [ ] No. of Lines ...........................Length of each line--------------------------....Total Length -. ..-------------_--.--.-----.--. <br /> 'D' Box-----...- --Type Filter Material........ ...........Depth Filter Material_--.--------------.------...---....._.-.--------------------- <br /> o� <br /> Distance to nearest: Well----------------------------Foundation-------_------.-.----.----Property Line----------------_-------------- <br /> SEEPAGE PIT { ) Depth_ _... .....Diameter-----..---- ---._.Number--..------•--------------------- Rock Filled Yes ❑ No <br /> WaterTable Depth-------------------- ------------------------------------Rock Size...-----........---- - ----------------------- <br />+ Distance to nearest: Well................ ....... ..------.......Foundation.......__-.----.-_.---_-.Prop, Line..-----.------_-..----_.- <br /> REPAIR/ADDITION (Prev. Sanitation Permit# -------- -----------------------------------?.---Date----.---.---._......-----------.--------------- <br /> Septic Tank (Specify Requirements)... -.Ae— t A.c �2 c 'L-- G-.-4- fcl......... .. <br /> Disposal Field (Specify Requirements)--.. r _..._/i/Cl.�'.+'?Y ...-.-. -CY.t�t�u�(------- <br /> ---------------------•---- ---._....---------••--------- -------------------------------------------------------------------------------------------------- -- ------------ ....... .........---- <br /> + <br /> ---------------------- ........................................................ ...---....---------------------------------•------. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I 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 v3ork'for which this permit is issued, I shall not employ any person in such manner as <br /> to become ylqect to W ap's Compensation laws of California." <br /> Signed... - - - - ------------ - ------r'---------_--------------- ------ Owner <br /> By.......- • . >•---------- ------------- :.. - ...Title-- <br /> (If other than+Gwner) <br /> FOR'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ 617' ------------• ------ ------------------....-DATE . h'. .z.`'7---- <br /> DIVISION OF LAND NUMBER--------------_-----_. . .........-...DATE.------•-----------. <br /> ADDITIONAL COMMENTS..___........ . ....... ..... ............. . ...-- - -----------------------------------...- -------- ---_---------------- .-- . ...... <br /> ....-.-........._. <br /> ------------------------------------------ - - . <br /> Final lnspectlon by:..... .. ----------------------------- --Date-... .' �i.'?9 <br /> EN 13 24 - _ SAN JOAQUIN LOCAL HEALTH DISTRICT �21677 REV. 7/76 3M <br />