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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> "------------------------------- - ------ <br /> (Complete in Triplicate) Permit Na.. .-. -1 - 4 <br /> -•-----•-•-•--•------------- ----- - ---- pp <br /> _ " -P <br /> ._ Date Issued- "-7'Z-... <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 /> 4 - . - ez-ZA0 . C1 NSUS TRACT.. <br /> JOB ADDRESS/LOCATION.....,1..- ..-... <br /> Owner's Name , Phone. :^ -3 ,3. <br /> - .... ---------- --- <br /> Address---- - --• ".............. <br /> - - " -- ..Cit � - -...Zi <br /> Contractor's Name........ .................License Phone-_. .. 5a �l+---.-. <br /> 1 . <br /> Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other-` --------- <br /> Number of living units:...... -----Number of bedrooms--,...Garbage Grinder---.----.---Lot Size.--fGd .... �-... :_..--"-..-- <br /> Water Supply: Public System and name..;-_- ---- - fig: ............. ------..--..Private ❑ <br /> Character of soil to a depth.of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loom 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 reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ <br /> r � e <br /> PACKAGE TREATMENT [ ] SEPTIC TANK <br /> ,�} Size "_:-_-."--- "-_"--------.Liquid Depth.-:'��.� ....-.-.....Q <br /> Capacity-/a�-_----•Type�lfl,.P- --Material_..S�OY�•G�..--...-:No. Compartments-,.-- ---92 ............ <br /> F�,- —r <br /> Distance to nearest: Well._"----.- � - .Found -. <br /> ation. A0. -.."..... -- Prop. Line-Z---------.-"."---"-- <br /> LEACHING LINE No. of Lines..........c:;L.............Length of each line -IO.Q...... Ql0.1-_Total Length - d-G <br /> /� ,,�r�� pp ---...- <br /> 'D' Box.....�.Type Filter Moterial4,-[I*-�c�- Depth Filter Material_...f?- -".--------------------------""-----.""----"-r' ' <br /> Distance to nearest: Well--- Foundation.---AO ---------------Property Line--- -------------------- <br /> SEERAGE-PJT [Lj� Depth../h.- "----134eme�ter�- _�_ Number-----------P ---------------- Rock Filled Yes ElNo ❑ ' <br /> Water Table Depth S ------------------------Rock Size-_-c X,3...--------""-"----------- <br /> Distance to nearest: Well-_--- ...... --------.--.Foundation---/.. -d-- -.-".Prop. Line_6.-------- f <br /> REPAIR/ADDITION (Prev. Sanitation Permit#..........................-...........-...............Date------.._..-------""------ --------"".-------"1 n <br /> Septic Tank (Specify Requirements)....:-.._r.... ---- - .-•-- <br /> -- <br /> Disposal field (Specify Requirements)."--'............ ... . ---._ .--. <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 /> certify that in the performance of 'the work for which this permit is issued, t shall not employ any person in such manner as <br /> to become subject <br /> wo Workman's Compensation laws of California." <br /> Ko Signed------ �L . - Owner <br /> t <br /> By---------------- --------------------------•---------- 6 -1 '°r�XT� Title �a. <br /> (if other than owner) <br /> /POIly DEP TMENT USE ONLY i <br /> APPLICATION ACCEPTED BY----......- -----------_--------- -"........-DATE .-- :W <br /> DIVISION OF LAND NUMBER.... .......... . ...............DATE..... ...---...-........ <br /> ADDITIONAL COMMENTS -- •-- ------- --."... <br /> ".--- "------""----------------- "."-----""-----......------ . ........ -------. -. ----- ........... ----.....--•---- "---------.-...---• "--.---...----------.. <br /> -- ------..-"------- ---------- <br /> Final Inspection -... ---- ---------- --"---Date. [-`f �J-.-...-. <br /> Fas <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT 21677 aev. ane 3M <br />