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FOR OFFICE USE: APPLICATION FOR SANITATION PERMI FOR OFFICE USE: , <br /> T...."_"`~~. i <br /> ------------------ - - - - -- - - - ------ <br /> (Complete in Triplicate) Permit No._7____ ._-._----. <br /> --------------------- -- --- - - <br /> ------------- ----- <br /> Date Issued_._6'_.---_Y_ <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 ADDRESS/LOCATION CENSUS TRACT----------___-_.-_--_._ <br /> I_ <br /> ----- eOwner.s Name _ <br /> ? ..,�• <br /> Address - = cr'� ��' ". _ -- - -- - City Zip `I <br /> .� �� d ,. l <br /> Contractor's Name----------------� ----__ -- --- - --'- '_-- d <br /> License Phone-- _`�_F40.7__-` <br /> _ �. ! <br /> ;r v se ❑ Commercial ❑ Trailer Court El <br /> Installation will-serve: � Reslaence Apartment Houi <br /> A ❑ OtHer------------------- ------ ----- r i , <br /> Mote <br /> Number of living units:__-,_ ___--� NPmber of bedrooms`. cGarbage.Grinder__.:..__._:_Lot'Size__ �___ �"" !' <br /> ;r <br />{ <br /> Water Supply: Public S sternrctRd=name_-_ <br /> ---- €--------------------------=------------------------------ ------- ----Privatel.❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Clay ❑ `r_,Le` �❑ Sandy Loam ❑ Clay Loam ❑ I Nr <br /> " -1��~�~ <br /> Hard an E' ' Adobe Fill Materia!__...__.._ If es, pe________________________________ i <br /> p ❑ Y tY <br /> [Plot plan, showing size of lot, location-of system in relation t'we[Is, buildings, etc..must be placed on reverse side.) <br /> NEW INSTALLATION: ;{Noseptic tank or seepage pit permittees_ f_Public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK .[ ] ...'_ `S e> 1 x ' - --Liquid Depth- -. <br /> Capacity._ -= Type = Materi"��-- --- ----- `----._--No. Compartments ---- r <br /> 1 <br /> .. . . . . Distance-.to nearest: Well-------------------------------------------Foundation-------.-=--=---=-=-..._-.__Prop. Line----------------------------- <br /> LEACHING <br /> ------------ ---_-.LEACHING LINE [ ] No. of Lines----------_____---------------Length of each lirie---------------------------------Total Length ---------------------------------------- <br /> :'D' <br /> ---,-, ,-.-,.,--_---__-.---.--_--_;'D' Box _.___:_.Type Filter Material---------------- --Dh Firer h71`aterial; '--- -- <br /> Distance:to nearest: Well_t' '___ ---.Foundation--- .-_--. -'_----__ _Proper Line <br /> SEEPAGE PIT [ ] Depth------ ---------Diameter_:!_-_ __._- -Numbed___ ___ Rock Filled Yes ❑ N�` <br /> .- ', <br /> + Water Table.Depth------ ----------------- - ---- -----------.Rock Size._. <br /> . _. . <br /> Distance;to nearest:Welf.- ---------------------- ---�---__-_--Foundation------ <br /> '--"---. -- ---Prop. Line------------- ' <br /> REPAIR/ADDITION;{Prey. Sanitation Permit-#------------------ _____' <br /> ------- <br /> I <br /> ' _ <br /> -------- <br /> Septic Tank (Specify Requirements) = = = -----------=----------= <br /> Disposal Field (specify Requiremnts) K .- <br /> v <br /> t <br /> -----=-------------------------------------- ------- , --- ------ ---------- ---------------------------- - ---- --- ------,------------------------------ ----------------- - <br /> t {Draw existing and required addition`on reverse side) i e T <br /> I hereby certify that have!prepared this applicatie'{and that the ;work will-be-done in =accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of•the San..oaquin Local Health District, Home owner or licensed agents ,. <br /> signature w <br /> certifies the Folloing: II'} <br /> "I certify that in the performance of the work for which this permit'is issued;'t !shall not*mploy any person in such manner ash <br /> ----------------- - '-------- --- ---- - ------- =-- - California." y � <br /> - <br /> _ p <br /> to <br /> Signed <br /> :Subject to Com Compensation- laws of Owner <br /> C -. , { <br /> B -- ----- -'-- -------------------- -----Title------�- !_� _1---- ------------- --------- ---------------- I�' <br /> Y- [ `her tha o r] ..= {. . .: I _ .y _ <br /> C R" PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ �'z` :----------- - i ----DATE. - ----'---� ' + <br /> DIVISION OF LAND NUMBER:----- : =------------ - .................. ................•-J--•---DATE-------- ------------- - ---- <br /> ADDITIONALCOMMENTS------------------------------------------------7----------------------------------------------------------------------------------=-------------------------- ------------ J. <br /> t : - <br /> = -------- -------------- -------- <br /> ------------------- <br /> -------------------------------------------------------- ------- ---`- -- -------= ----•------•------------------- ------------------°------------------------- --- ---- ------- <br /> = - <br /> �.e. ., - - --------------- <br /> _ _ <br /> ------ -- <br /> Final Inspection by: --- <br /> AEA <br /> - =- <br /> s; Date <br /> EH 13 24 SAN J AQUIN-LOCAL H AL�TI4-D.ISTRICT F&5 21b77 REV. 7/76 3M <br />