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FOR OFFICE USE. <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit <br /> ---- ------- <br /> ----- ------ (Complete in Triplicate) <br /> Date Issued_&?-,�.y=,7,6 <br /> ------------------------------- - <br /> ------ This Permit Expires 1 Year From Date Issued <br /> ----------------------------- ------------------------- <br /> - <br /> and install the <br /> Application is hereby made to the San Joaquin Local Heoth Dstro 5or and existing toconstruct <br /> R str and Regulations work herein described. <br /> P pOrdinancet -This application is made in compliance with County <br /> �. <br /> --�—.��~ ----- TR <br /> C�'C CENSUS ACT.. . <br /> JOB ADDRESS,/LOC#TION.:_- -- - <br /> ------------- <br /> Phone. <br /> i <br /> .Q <br /> G Q <br /> or= <br /> - <br /> �+ner'sOwName------ •ty. <br /> Address -.------- -- :---- --- 6 SPhone <br /> License <br /> - <br /> ' ` <br /> Contractors Name. Apartment House ❑ Commercial ❑ Trailer Court ❑ ' <br /> Installation will ser e: v' <br /> Res-: Ap { <br /> Mtel ❑ �`O`her-- : : ---------- <br /> o = -•� <br /> n �1,50 <br /> t,. <br /> --- --Garbage Grindex._... -------Lots Size------- ----- ------ -- -� =------ ----- ---------------- <br /> Nu <br /> ---- - <br /> 3 f Number of.living units----- ----------Nu,ber of bedroom l _-__private ❑ <br /> - -- - - - <br /> Water Supply: Public System .and name- - ----- -- - - r-7� Clay Loam <br /> t Silt .A Clay ❑ Peat ❑ Sandy Loam ❑ Y <br /> Character of soil to a depth of 3 feet: Sand ❑ ❑ �, R + <br /> i l-- ---If yes, type----- <br /> 9 Hardpan ❑ . Adobe, Fill Material.. <br /> M <br /> F ',size of loj, location of system in relatio'kto`,wells, build•+ngs, etc. must be placed on reverse side.? <br /> (Plot plan, showin t -• . r :._ I... " <br /> :W.. > . . <br /> r /! <br /> 9 <br /> NEW INSTALLATION: �(No septic tank seepage pit permitted if public sewer is a�a+Ihle�+th'L+20�{Depth._���--�--- --,--- <br /> s <br /> �. " _ q <br /> Size �J <br /> SEPTIC IANC 1 '1 ,., <br /> PACKAGE TlZEATMENT [ l ----------- ------ <br /> r <br /> Cepa y Type <br /> f" eriak = � No.,Compartments.T <br /> I t �t - • -- --------Four tion. a _ Pop. )rine C� �r� <br /> D'+stance;t0 riedre �V+fe11 ---------------- <br /> h - ----------- <br /> d I • <br /> ------ <br /> r <br /> 4 e Length.of each line.__-. .Total;.Len th.:_ qr <br /> LEACHING LINE [ ] No. of Lines - -- -- / l / - -- - -. <br /> ----------- <br /> D' <br /> -- <br /> � � ..'D' Bo x.l_-----Tye Filter Material? �-�-Depth.Filter Materia! ;��} -- -- --: -- - ------- ------ fi <br /> �. <br /> ,� <br /> Foundation_- `-'------------ <br /> Distance <br /> -- =---.Pr;operty Line-- --Q <br /> Dist ince to nearest: Well------------ Y N ❑{ <br /> s <br /> t N Rock Filled es o <br /> Depth.-_--- Diameter. �w� <br /> SEEPAGE PIT [ l ; I ---------------------- <br /> W <br /> ------------- <br /> - �. -:Foundation -` <br /> •. Wer Table Depth - - ---- - --- -'- - •� �- --- -------=-- --- <br /> Roc ize-- ---------- -------- Prop. Line----------------------- <br /> at ' <br /> --`..-i t -----.------'- r <br /> Distance.to nearest: Well:`..-__--__. �..� - _ <br /> . ! - ----- --- Date_. =-------- <br /> ---- "-......_°-------- - <br /> REPAIR/ADDITION ( rev. Sanitation-Permit#---------------------- Y-- , <br /> r' <br /> = = 1 - ----------------------------------------------- <br /> Septic Tank Tank (S ecif Requrrem nts).......:.... .. �{ - <br /> Disposal Field (Specify Requirements) ' <br /> F - ----- .------------------------------ . .: •-- _ _ <br /> ------- - - <br /> - --- -- <br /> ------------------- <br /> '. --------------------------------------------------------- -- - <br /> - ------ -- _ <br /> i [Draw existing and required addition Lreers'e's"id e} I <br /> C 11application and that the .work will be done in-accordance with San Joaquin County <br /> I hereby certify that•have-p pared this app • =a uia Local Health District, Home owner or licensed agents <br /> Ordinance), State Laws, and Rules ]and Regulationf the San Joaq -E <br /> signature certifies the following: t�'t� + <br /> a erson in such manner a! <br /> "I iertifyjthat in the erformance of the work for which this perm4 is issued; I sh'nll'nof employ any p <br /> ' ec o kman' ompensation laws of, California.". <br /> to become j f <br /> ------- ------- -------- ---- Ow <br /> 3 ner <br /> Signed.. ------- <br /> ---------------- <br /> ------- <br /> . r <br /> ------ --Title.- --'- - • <br /> BY- ---------- - g <br /> (If other than owner) 6 <br /> -- -- -FOR-DEPAR•TMENT-USE-ONLY <br /> _... - ----------------- <br /> 4)ATE.--�- ---- <br /> = <br /> APPLICATION ACCEPTED BY-=� ---- ------ ------- =-=-- DATE---- �--- �=�--- -- --_- ------- ----- <br /> ----------------- <br /> ' ----- _ ., _- --, <br /> t DIVISION OF LAND NUMBER.. _ �,---- --.- --- -- <br /> ---- ----------- ------ ---- <br /> -------------------------------- <br /> s, ADDITIONAL COMMENTS --Y <br /> -------- ------------ ------------------------- <br /> ­-I <br /> ----------- -_ ------- <br /> ii ----------- --------- <br /> ----------------------- <br /> e ---------- . ----------------------------------------- <br /> ----------- <br /> C ----- <br /> ----------------------------------- Date.-------------- <br /> •Fina1=inspection - -----------•- <br /> r&s 2+677 Rev. 7176 <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />