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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />......_.... •-- •-•......... ..... ...... <br /> Permit <br /> --- --- <br /> No. <br /> (Complete in Triplicate) <br />..:.... .............................................. Date Issued!a:Z­:.7 <br /> This Permit Expires 1 Year From Data Issued <br /> col e work <br /> Application is hereby mode to mean tom compliance with eCounalth DtytOrdinance rict for a No549 and existing Rulesrmit to construct ind talndhRegulatpn�rein <br /> described, This application 'is A <br /> Q1 D.. Z. .►.._S OCk'Ijd .r._C 4...... .........._CENSUS TRACT .....................:.... <br /> JOB ADDRESS/LOCATION .. �� ._.� �•--- - g48�6g4 <br /> " udy...and Dm in ..R ender.............:...... ...................`..,.,_._....Phone ...._-._.._.........__........_..... <br /> Owner's Name <br /> g� 26 ' 3?¢ 465--$79�........._ <br /> Address .. ._.. 2� .� ' ifllf3^GB :... �� y ... -.. . .... ...................................... <br /> City <br /> D8 2�7 4;3 C ' elk 8: Sewer' £�•_.License # ... -- __ -_... Phone ................. ------------ <br /> Contractor's <br /> -•--. --Contractor's Name '... .,]' ........_.:.. ...... . - ----- ---- ------ ----- <br /> Installation will serve: Residence ® Apartment House Commercial ❑Trailer Court :❑ <br /> Motel ❑Other .... ._... -------------------------- pt 6101 <br /> no _..,..- ......... <br /> W <br /> Number of living units:]......._.. . Number of bedrooms ..�-.....•.Garbage Grinder .-.--.--.-•• Lot ;ze <br /> Water Supply: Public System and name _..CA1;k •..:-y�'t- r__Service_ -00- ----------................---- --•---..Private ❑ <br /> Character of soil to a depth of.3 feet: Sand n Silt❑ Clay ❑ feat C3 Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ 'Adobegg Fill Material ........._ If yes,type ..............__.-.-._.._. - <br /> Tr <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side-le <br /> NEVINSTALLATION: (No septic tank or seepage pit permitted if public sewer is available withn 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK [ I Size........................ --- ..... .... Liquidp �I <br /> Capacity _. ... . _..,. Type ---------------•---- Material.........---- - --• . <br /> No. Compartments ------ -•------- <br /> Distance <br /> • --Distance to nearest: Well - ---------.,Foundation ............. Prop. Line --------------------- <br /> 401 <br /> ------•--------•-•--40t " Total Length _ -� .--• <br /> LEACHING LINE �& No. of Lines . �,.�, .. _ Length of each line. <br /> ............... <br /> x�o ek 1$a <br />� _De Depth Filter Material _............ .... --- <br /> 'D' Box -ZV ... Type Filter MoteriaE ..--•--•-•-•---- P t <br /> r plus- Property Line . .......... ......... <br /> Distance to nearest: <br /> Well __p4P .P.•------- Foundation ------ p <br />[ �- ..---_----,..•.... Rock Filled Yes ] No Cl <br /> �F � <br /> SEEPAGE PIT [ ] Depths U_ *.A.�_. Diameters X4� Number -- <br /> n tt <br /> - •------.•-•-Rock Size ......-�...------•---- 1 <br /> Water Table Depth _..:..��---•-.•------•-------- • t <br /> E3tt{ �t9 Foundation ... ------------------- <br /> 1.01.. <br /> Prop. Line .... ............... <br /> 1 Distance to nearest: Well ......3?___________________•------- - <br /> 1 ._ Date ----•---•.........................1 . <br /> REPAIR/ADDITION(Prev. Sanitation Permit --_-.---.--�•-��- <br /> � � Septic Wank {Specify Requirements] ...... ..........--- ------- --- •--------------..._..---..._...----•-----•--- ._...-.... _. .. .-...._:..._..-•---..- ....._...... <br /> ._ <br /> 40 pf leach and one........ - <br /> . -.Y <br /> ..................... <br /> A h back hoe,- to...��:�-.atine. -�--��-------... I-------1­--- --- - .. <br /> � hg_._.y <br /> -..T................. y. _.........._--'-"--.....-..._.--....--'-----..__._....---'--....._.....---.._.._._-------_- ---------- -. ... ..----.__._.----- -...__.--__--- <br /> (Draw existing and required addition on reverse side) <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations 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, { shat{ not employ any person {n such manner <br /> as to become subject to Workman's Com ation laws of California." <br /> tSigned �— "....... ... ........ ... ....••---: Owner <br /> By _. .... ... <br /> Title Contractor .._- -- <br /> of er a owne er> 0• tf"O <br /> FOR DEPARTMENT USE ONLY _ <br /> v �...f _. . .... . _._ .. -_._.. ..DATE.� ...r P-•-�---------- --------- <br /> 'I _ _ _ DAT 1-�` <br /> APPLICATION ACCEPTED BY ... ._... � ---------------_._---------...... <br /> BUILDING PERMIT ISSUED ------ . • •-••.• <br /> ADDITIONAL COMMENTS . <br /> ... <br /> ..•-----•.... - _ _ ------- ----•----------- ate ................------ ----• --- ........... <br /> Final Inspection b __ _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/72.3 1� <br />