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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------- ---- Permit No7 ---- <br /> (Complete in Triplicate) <br /> ---------------- -- - -------------- --------- <br /> ----- Date Issued--- <br /> ------------- ------ - <br /> ssued__.___.__________________ ______._..__._______._.______-. 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-Eounty-Ordi-nonee-No.549-and-ex-isting:Rules-and-Regulations:- w _ <br /> JOB ADDRESS/LOCATIONQ-. .. --- CENSUS TRACT.-----------------------. = <br /> Owner's Name- ��L_ -� -- --- -----------'- ----- Phone---------------- ------------------ <br /> Address------------ ��_ y w.4 UY ------- K_.... .Cit ----------Zi -- <br /> Contractor's Name_-'- ----- - -------License #-3-z ?-2,�--Phone---------------------------------- <br /> Installation will serve: 1 Residence Apartment House_[] 'Commercial ❑ -Trailer Court ❑ <br /> ► .- . s ..! .. . .. . b Motel ❑ Other---------------------------- "--.._-'----- <br /> f Number of living units ._.-'------Number of bedrooms____ ____Garbage Grinder_________=_Lot Size_.,._.__._..._.-----------.. ----__.__._ <br /> Water Supply: Public System and name_________________________'__ $ ________Private ®� <br /> i Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam E <br /> ] hardpan ❑ Adobe❑ Fill Material.__._--- _If yes, type-------1bb-;;+-------------- <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 sew r is available within 200 feet,) W <br /> PACKAGE TREATMENT rSEPTIC TANK ' [ ] Size------------------------ ---- ------- w---------------- Liquid Depth.------------- -----� <br /> Ca aat i <br /> p Y--- --� -------=Type -- -----------Material _----- " - _._.'.No. Compartments------------------------------------ <br /> ....`Distance to nearest: WeIL;._ ------- -----------------r.Fo r4 --------- =" ='- Prop. Line---------- --° <br /> LEACHING LINE „ ----- ---- -------Length of each lines.-. -----------s__; ._..__ .Total Length..---.----;,,:-----------:---------- <br /> m <br /> ! ; •'D' Box--;- I.-Type Filter Material ------------Depth.Filter'Material--_i ------------------------------------------ <br /> �* <br /> Distanceto nearest Well_;_ _ ___ __Foundation_ `Property Line_.________ <br /> I SEEPAGE PIT [ ] Depth :.__---- _ Diameter.....__.-, _____N,umber : __ ------'._____.. 1 ,Rock Filled Yes EJ No,❑ <br /> Water Table Depth------------------------- --- - -- ---- Rock Size----- - --------- -------- <br /> bistance to nearest: Well - = -Foundation Prep. Line---------------- ---- }� <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------7 3_ _ 4�.y--------------------:Date--/•2--12---7 ----- ------------1 <br /> SepticTank (Specify Requirements)----•---- ----- -- --1' ------------ --==--:==------=----- -- ----- -- ------------------------------------------------ ------------ <br /> Dis�posal Field (Specify Require encs):---------------------- ------------------ r ---- ----- ------ ------.--------------------------- ---------------- <br /> = --------------------------------- ------------------ <br /> t ` `------------ "7- 2` - e----- <br /> (Draw exi ting and requited additionrse side) <br /> I hereby certify that-I have prepared this-.application and that the work will b'e 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: i <br /> certify that in the performance of'the'-work for'viihich this permit is issued, I shall not employ any person in such manner�as <br /> to become subject .to.Workman's Compensation: laws.of California." <br /> I ( <br /> Signed--------------------- - - ---------------------------- ........ <br /> .. TOwne�r --------------- <br /> By <br /> " - - -BY- ---.--- -------------------------------- <br /> --.----.- -- ------------- --- Title__ <br /> (If other than.owner) <br /> i .F. _.., .. .. FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- 'r <br /> --- <br /> DATE ___ <br /> DIVISION OF LAND NUMBER------------------------_ ..- ;_-- -_ .. - = DATE <br /> _- - <br /> ADDITIONAL COMMENTS----------------- } <br /> ---------------------------------------- ----------------------------------------- <br /> I = _ --------- ------------------------ <br /> ---------------------------------------- ----- -- - <br /> i - <br /> i . ' _ .______._ _ _ ____ <br /> 71 <br /> Final Ins ection b _ .-.... - Date.-. �' = ---- - = <br /> er+ 13 snSAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677eev. ��r6 3M <br />