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FOR OFFICE USE: FOR OFFICE USE: <br /> .............. APPLICATION FOR SANITATION PERMIT Permit- No.7.F <br /> 4,7;to............ ............. (Complete in Triplicate) <br /> .................................... ............. ...... '�2 <br /> Date Issued.,a. <br /> ............................. .... ................. This Permit Expires 1 Year From Datk 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 /> z7 <br /> JOB ADDRESS/LOCATION.. .... . . . ..........................................CENSUS TRACT............................ <br /> Owner's Name...- ....0,z , 1�� Phone_............. ................. <br /> ..........I."_2e------------------- .......................................w............. <br /> Address------- q . ....._city.......... ------- ............... .......zip... ............ <br /> .. ... ---------------------- <br /> Phone- ij_ 49- ...... <br /> Contractor's Name.--..-- ............. ............__License #.-e <br /> 71?..7-n­at Z� <br /> Installation will serve: Residence n Apartment House E] Commercial [] Trailer Court 0 <br /> Motel n Other------- :------•--- <br /> Number <br /> ther---------------------------------------------- <br /> Number of living units:....I.,;_•_...Number of bedrooms..----...Garbage Grinder............Lot Size. ... ... .�4 <br /> Water Supply: Public System and name-...z__ ................................ .. . _.............I......Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat[I Sandy Loom E] Clay Loom El <br /> Hardpan n-- -A4k�be-8--FriI,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 /> PACKAGE TREATMENT SEPTIC TANK Size--- All/............... ...........Liquid Depth.1 <br /> __/----------------_ <br /> Copocity__Pt%W40---:Type. -, ..-..............Material- No. Compartments_ ................. —---------- <br /> Pjstance to nearest: Well.:_.._ ..................Foundation..../-V. .............Prop. Line-_.-_........ ... ------ <br /> LEACHING LINE No. of Lines.. -----------------Length of each line...-__- ..............Total Length .j_y..P...•--....•......I...... <br /> 'D' Box ype Filter Material_14.. Depth Filter Material... ............ ............... <br /> Distance to nearest: Well---------------------------Foundation.................... ........Property Line--------...... .............. <br /> SEEPAGE PIT Depth---.' - ...-Diameter......V_ .... Number...... -------I....... ock filled YesNoo <br /> 16 <br /> A� <br /> Water Table Depth.... •.......-••••••..... .. ............_ ..........Rock Sizq,....../ ......... .................... <br /> Distance to nearest. Well---------------------- .. .:: .____•Foundation...:.--- ...-:. ... ....Prop. Line----.---- ---•- <br /> REPAIR/ADDITION <br /> ine..... --------------------- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#................. ............ .._.......:..Date-_-. --::__---------- ----------•--------- <br /> SepticTank (Specify Requirements)...... ....................................................................... ........................... ....................... ------------------- <br /> Disposal Field (Specify Requirements)------ .......... ...........................................................�.61............ ................................. ......... <br /> .............................._...........­­....... ................................­­...................................... ............... .......I.......... ......... ...................... <br /> ...................... <br /> ............................ ........................................... ........................---•-•----------------.--_._.......... ..................... <br /> (Draw existing and required add tion_6n reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local 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 subject to Workman's Compensation taws of California." <br /> Signed . . ... .. ... ........................ ...........--------- ---Owner <br /> By........ ..Tow <br /> .............. - <br /> --------------------------------------------------- <br /> f a er than owne <br /> 71 <br /> Kft DI*RTMEVUSE-ONLY <br /> , <br /> /777 <br /> APPLICATION ACCEPTED BY.7--- tZ� .. <br /> .. ... . ... --- _DATE --- --- .. .......... <br /> DIVISIONOF LAND NUMBER................. ........ ............. .........-- ----- ...... .....................DATE..-------_-------_--.._.. ........ <br /> ADDITIONALCOMMENTS................. .................................. ---------------------------------------------------------•------- --------- ---------- -I- -------i-- <br /> ............................ ............... ................. ......................................................�r...................................I................. ....... ......... . ........._...... <br /> .................................... <br /> .................................. ................ ............................. .................. ............................................................. <br /> ............:...................... _---- # ­.... ..­ <br /> ............................................... ............i�e.... 7 <br /> ... ............ ...........................................Date:-..`7­. .. .... . --------------- <br /> Final Inspettion by:......... . . ..... --- -- ............................ <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FRS 21677 REV, 7/76,3M <br />