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FOR OFFICE USE: FOR OFFICE USE: <br /> i {-1--- ----------------- - - APPLICATION FOR SANITATION PERMIT Permit <br /> --------------�-4-�--- -- <br /> ------------ (Complete in Triplicate) <br /> �C- 7 <br /> Date Issued_ __ ____ _____7_ <br /> --------------------------------------------------------- This Permit Expires 1 Year,From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Districrfor 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'ADf7RES5f LQCATI pp ----------CENSUS CENSUS TRACT -------------------------------- <br /> Phone <br /> -------- ------ <br /> �L G �ai ------- <br /> _ e s :------ <br /> Owner's _ <br /> Phon <br /> lj = -----------Citi -------Zip ---- ------- ------------ <br /> Address----- G ( --- -----� q <br /> Contractor's Name->� .L- ------- License #Dt�P 1�� _Phoned- f <br /> Installation will serve: ResidenceK06 <br /> Xlpartment�House.❑ Commercial ❑ Trailer Court ❑ <br /> ------------- �, ` <br /> el ❑ Other----------------------------- -- \, <br /> Number of living units:____ _____Plumber of drooms_____ ___Garbage Grind ..<�'tot Size__/_/- �-�-f�3�-----------------� <br /> Water Supply: Public System and name----- -- -- -- _._ Private <br /> Character of soil to a depth of 3 feet: r Sand o( 5ilt❑ day ❑ Peat El �andy Loam EJ Clay Loam [It <br /> Hardpan F-1Adobe ❑ Fill Material_ ---------If yes,type-------------------------------- <br /> (Plot <br /> ._____ _________ _______-(Plot plan, showing size of lot, location of system in relatioin to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer lis=avatiaNe within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK 'size ------ _ ------------------°Liquid Depth- ' ____. <br /> Capacit� j_6�1_Jype. _ ate-rial_ No. Compartments _.__p . --F __._ ._ <br /> C r <br /> Distance to nearest: Well .; �� -= ._� ,=L } <br /> LEACHING LINE NO No. of Lin4s_!____�----------------Length QL eacb line 946 ___1Tbtal - - ----------------- <br /> 'D' Box !� .._Type Filter Material_ _ Dgp##i ilte?­MateriaL <br /> i ~` --- ---------- <br /> Distance to nearest: Well__ _ r ___, ounctattos4_•. V=- -=-.�'--.-_.Prope e - =----- --------- <br /> Dia�mPter Niimher --=--- ----------- �' : Filled Yes❑ No ❑ <br /> SEEPAGE PIT~fbepth-- '�.�- .. <br /> Water T4*e JDeptla------------------------------------ Rock Size-------------- <br /> Distance 461ngarest: Well----- --------------- --- -------------Foundagon - -------- -----------.Prop. Line--- -- ----------------- <br /> REPAIR/ADDITION <br /> ---- ----------REPAIR/ADDITION (Prev. Sanitation Permit_._. ..------ ..----�D.dfe---------------------------------------------- <br /> ----------------- <br /> ------------- ---- --------- -----------) <br /> Septic Tank (Specify Requirements) ;_ ------. - -- t <br /> i <br /> Disposal Field (Specify Requirerrtnts) ------------ ------------------------ ---- ;--------------------- �. - - --- ------------------ <br /> --- t <br /> --- - <br /> ------- -- ---- ---- -------- - --- -✓ ---- ,,fr ----- --------- ------ --- <br /> (braw existing and requiWd" lmddition on reverse side)`K <br /> I hereby certify that I have prepared chis application and that the awork will be done in ci rcoM*cii ice, wifh-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 thet,'vvork for which this permif is issued, I shall not employ any person in such manner-as <br /> to become subject to Workman's Compensation laws 11of California," CL1tP,ENCE'S SEPTIC & SEWER SERUICB <br /> Signed-------- ______-__'__;.Owner 263 So. Oro � Stoc!.ton, Calif. 952051 <br /> ----- <br /> g ------ -------- Title_ _-,I'h.403-;2p9-----Contractar's-Lac..y;267.,.17,E <br /> (If other than ,own <br />` R DEARTMENT USE ONLY T;7:24-77,/ <br /> APPLICATION ACCEPTED BY kY - DATE. { <br /> z --------------- <br /> DIVISIONOF LAND NUMBER--------------------- - ------------------------------------ ------------------DATE----------------------------- -- <br /> ADDITIONALCOMMENTS-------------------------------------------------- --------------------------------------------------------------------------------------------- `----------------- <br /> ------------------------------------------------------------------------------------ ----- -------------------------------------------------------- ------------------------ <br /> ------------- ------- ---- ----- - <br /> - - - --- -- - <br /> Final Inspection by: � 1 �__.__wQate.� __.Z <br /> EH 13 24 SA AQUIN LOCAL HEALTH�DISTRICT` ' F&s 21677 REV. 7/76 3M <br />