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FOOR OFFICE USE: F�;:�O�F1Ct USt: <br /> IAPPLICATION FOR SANITATION PERMIT qq . qq <br /> J `'------....------------------------------ (Complete in Triplicate) Permit No.�.l.- ./ .... <br /> -...... Date Issued_j-: `-7f <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: I <br /> JOB ADDRESS/LOCATION.... ....... �Y�-..t_. 74.uIL(. �^------.CENSUS TRACT_............... <br /> Owner's Name .__2_71.x.. ......4NQ ,�LS�/�.�-�-y._. �/./l�C� --------------_------ ------Phone.....R3.-&— 4.z_7 <br /> Address-- - <br /> .. - Z :I-- ..- I <br /> Contractor's Name......................d.W.`h ......--.._... License #- Phone-.... ---- <br /> Installation will serve: Residence"k Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> /Motel F-1 Other.- .--. ------ <br /> ------------- <br /> Number of living units:-..../-------Number of bedrooms.��..Garbage Grinder/Y4?.. Lot Size----- .D. l -_ ------------------- <br /> Water <br /> ..- ------- <br /> Water Supply: Public System and name---- --- -------- A'i,G',� Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam [] 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,) p <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size ------ -- ------ -------- ---Liquid Depth...--_............. <br /> .•---- <br /> Capacity.......................Type-----•-----------------Material-------- ---No. Compartments------------------------ ----------- 1 <br /> Distance to nearest: Well--------------------- -- --- --------------Foundation..---.- -- . -------------Prop. Line__-------._.---------_.C� <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 /> i <br /> SEEPAGE PIT [ ] Depth.. . ....Diameter--------------------Number-------------------------------- Rock Filled Yes ❑ No❑ <br /> WaterTable Depth..-------_.-_----------------- ---------- ---.......Rock Size.-. - ---- ---------------------•-------------- <br /> Distance to nearest. Well...----.-. ..Foundation................ .........Prop. Line-------_--______-_---... <br /> PIZCI t33q� <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.. - -------Date-------------_ ---- <br /> ---SeSep!ic <br /> ptic Tank (Specify Requirements)---- - ---- ; Ij ----------- --------------------------=------------ ------ ---.......... .......... .... <br /> Disposal Field (Specify Requirements)... ..LYrrS `/ ----- yX_ ... ...lCl--------gy m <br /> I <br /> ...... . ----- ...-. <br /> I. (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> i <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 s Wi n's Compensation laws of California." <br /> -------------- Owner <br /> By................. ............ ..........•------ ........................................ Title <br /> (If other than owner) <br /> FOR REPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.- '` r'"` ---- ....-bA7 r `�` <br /> DIVISION OF LAND NUMBER...................... ... . DAT -- ---..-- I <br /> ADDITIONALCOMMENTS ...... ..................................... - --------- --......_. . - ._..... <br /> i <br /> -------- <br /> ------------­-.­:.-•.----- - .............-------------- ----------------- .................... --------------------------------------- <br /> Final•Inspectlon by:------- ---•--- ---------------- ------Date..... ---. -------------- - --- ----- <br /> EH i Fas z�azr REV. ���a 3Mza ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br />