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T <br /> FOR,.OFFICE-'USE: rl �i 7 <br /> APPLICATION FOR SANITATION .PEW <br /> -7------------------------ -------------------------- Permit No. <br /> --.-(Complete-.in.Triplicate) <br /> ---------- ....... <br /> This Permit Expires 1 Year From Date Issued Date Issued __!7,-� --:7./ <br /> ------77 <br /> ------------------ <br /> Application is hereby made to the San Joaquin Local Health District for a per'mit to construct and 'install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> i" <br /> JOB ADDRESS/LOCATION --------------------- --------------------------------------- -------- ---- -CENSUS TRACT -------------------------- <br /> Paul and Claudia Larsen <br /> Owner's Name - ---- - -------- ------------------------------------------------------------------------------------------------- --------------Phone ------- <br /> Address3-5.241---B_e_Zug-------------- ---------------------------------------------------------------------- ------------ city _-L-od.1-------------------------------------------------------- ...... <br /> Contractor's Name ...P-11 a -7 L_---e---a----SP-PUA__T_ank__S_e_rV_iee-,-------------License # ---Z61-73.17_----- Phone _3.69.17$2_.._.___ <br /> Installation will serve: Residence-M Apartment House-,E]-CommeFrcial-E]Traite,r Court iE] <br /> Motel Mi Other-------------------------------------------- i Vex <br /> Nu i mber of living units:--7.il Number of bedrooms __3-------Garba-g e Grinder _._n0`_ Lot Size _---11$__-S-_1-75----------------- <br /> 1 <br /> ---118---X--l-75-------------­- <br /> Water Supply: Public System and name -----------N_ I-----------------------------------Private <br /> Character of soil to a depth of,3 feet.. Sand'[] Silt [:1 Clay 0—Peat 0 Sandy Loam [ [ Clay Loam E] <br /> Hardpan EJ Adobe E] Fill ,Material --------- If I s, type ---------------------------- (A <br /> X; <br /> (Plot plan, showing size of 1,6t, location of system 0 buildings, .etc. reverse side.-) <br /> �in relation t rwells, tc. must be placed on revE <br /> NEW INSTALLATION: (No septic tank or seepage 'pit permitted,'if public .seweris-available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK f Fxistfng ---------- Liquid Depth ---------------------­ <br /> Capacity Type MdteriaI___ ----------- No. Compartments -----------------=---- <br /> E Distance to nearest; Well ---- <br /> --------------------------------Foundation - -------------------- Prop. Line ------------­-------- <br /> LEACHING LINE No. of Lines ---------------- Length of each line--.-74!------ -I- ------ Total Length ------------------- <br /> 'D' Box _,V_e8--- Type Filterrm-6ter-iai—iro-ok-----Depth Filteq Material __.____1$n_____________________________ . . <br /> Distance to nearest: Well ______L Foundation ---10M--------- Property Line ___51---------------- <br /> --Number,._.-_.,-............ Rock Filled Yes E] No C3 <br /> ,SEEPAGE PIT Deptg.-..--.------ -------Diameter—---------- <br /> t <br /> Water Table Depth -----------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------j----------------------Foundation -------------------- Prop. Line ...................... <br /> 1 n_ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------f__`________-_______.__ Date ---------------------------------- <br /> Septic Tank (Specify Requirements) , ---------- ------------------------------------------------------- <br /> -------------------------11------------------ --------- <br /> Disposal Field (Specify Requirements) "D"--,box- _t -exi- _0� -at <br /> -------- - ------- ------------------------------------ ---------iri Stem-------------------- ----------------------------------------- ----------------------------------------- <br /> ------------ -------------------------------------------------------------------------------- <br /> ------------------------------------------------ ------------------------------------------------------- <br /> (Draw existing and required additi6n on reverse side) <br /> I hereby certify that I have prepared.,this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulatio'ns"of-the San Joaquin Local Health District. Home owner or licen- <br /> sed agents 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 <br /> as to become subject to Workman's Compens on laws ;fC dliifornici <br /> Sled --- --- ----------- -- -- ---------- .1 <br /> ign ----- --------------------------- Owner <br /> By ----------I--------- <br /> -". Title ----Contractor--- ---------------------------------- <br /> oth r owner) rry 0 Warthan <br /> FOR DEPARTMENT LESS' ONLY <br /> APPLICATION ACCEPTED%BYDAT�,'­e`_ -7-7-1---------------------- <br /> - ----------------------------------------- --------------------------------- ------------------ <br /> BUILDING PERMIT ISSUED a <br /> ---------------- --- - -- -- ------------- -------- ---------DATE = =----------------------- <br /> ADDITIONALCOMMENTS ----------------------------- ----------------- -------------------------------------------- ----------------------------_-------------------------- <br /> ------------- ----- --------------------------------------------------------- ----- -------------------------------------------------------------------------- ------------------------ik----------- <br /> ------ - -------------------------------- --------------- -- --------- <br /> -i - ------------------------------- ----- --- ----------------------- <br /> (___ __—----- --------------1�. ------------ ----- ---tZ <br /> ------------------------------------ ------- <br /> ---- ---------------------------------------- ------- <br /> ------------------- ------ - -- --------- -Of <br /> - ---------------- -------------- ----------------- Da <br /> G6_1 Inspection by: --------- --- ------------ e. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br /> P% <br />