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FOR OFFICE USE: ^ FOR OFFICJ WV. <br /> �(/ >�V APPLICATION FOR SANITATION PERMIT %^ <br /> . o <br /> 4!'""F �... .. Permit <br /> f (Complete in Triplicate) <br /> V <br /> Date Issued- �. -7�� <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 ADDR SS/ OCATION.. ..1...--l�O.-.-- &.ATFE.M. _.....CENSUS TRACT . ---..... <br /> Owner's .............Phone-4 7..'A3-/--- <br /> Address.3�.t. L?ka�L�Ef2_-. --City- , CkAo1�.. - -- ZiP <br /> Contractor's Named. C.leLf.fl.D--- '---`ST•---------- ----- ------...License .Phone. b�-- * <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ v <br /> Motel ❑ Other------- - --- - -------_------------- <br /> Number of living units:-----.G--.......Number o bedrooms..©---. Garbage Grinder_Nl�...Lot Size---1.5- X.Ito - - --- <br /> Water Supply: Public System and name._. ..C...:..V_ ATE/L.... ........... .........................•---------• ------ - ----- - -- --------- - <br /> ......Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ AclobOZ 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 /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size.-._--_---- -----------------------------_-----------.-Liquid Depth.............-..-.-----_--- <br /> Capacity------- -------------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 /> Distance to nearest: Well------------------------- --Foundation----_-_---_--..------.---Property Line......--------...------------------- <br /> . <br /> SEEPAGE PIT [ ] Depth..-------- -----Diameter..-_--_-_----_.Number.------------------------------- Rock Filled Yes ❑ No E]Water Table Depth:-- • ..... ------------------------- -----Rock Size.----------_---- •- -_-- <br /> Distance to nearest: Well_............ .. ......... ........Foundation....--------- . . . ----Prop. Line -------- <br /> k� <br /> REPAIR/ADDITION (Prev. Sanitation�Pgmit#....................... ..... ..... .........Date-------- -------- - ....-------------- <br /> C� I s, <br /> `5 l�,-..c%c��.-.- : AQ� <br /> Septic Tank (Specify Requirements).-t-f -...-..... ---- .-L- 1 `�1' semf��" 1 <br /> Disposal Field (Specify Requirements)-+v-....5£ALSE.....0_X --------------- ------ <br /> v i ' <br /> - ------------- -•---.----- ------ ------------ --------------..............----------- - - <br /> �- 1�- ---------------- - - ------ ---• <br /> 644�-�- ------- <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 work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to rkman's Co tion laws of California." <br /> Signed...--- ------- _.. .. Owner <br /> By••----•-•----•--- --- <br /> Title-------- ------------------------------------------ ------- ------- <br /> - - - - -- --- --- - <br /> (if er th n owyr�f) <br /> (/ F R TMENT USE O LY <br /> 01 1110 APPLICATION ACCEPTED BY.. • T/ DAT --. -f��- ----- <br /> ------- <br /> DIVISION OF LAND NUMBER--------------- ----- ------------------------- DATE.......------ ---- --... .--------- - <br /> ADDITIONAL COMMENTS.. ---------- ? --• -•--------------------=---------------•- ----------- ---------------------- -- -..... <br /> ------------------------------------------ <br /> ....-- . - ------------------- - ------ --------------------- ----------- -- ------ <br /> Date L -- >-----� s. <br /> Final Inspection by:--. ... /--7 � .. <br /> ---------- •---•- --- - <br /> EH 13 24 SA J AQUIN LOCAL HEALTH DISTRICT Fas lien REV. ane 3M' <br />