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FOR OFFICE USE: FOR OFFICE USE; <br /> APPLICATION FOR SANITATION PERMIT `•-----•-- ----" X$ <br /> �.S� <br /> (Complete in Triplicate) Permit No....................... <br /> ......•................"•................. .........".." This Permit Expires 1 Year From Date Issued Date Issued._.3 <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/LOC ION..... .. .._.. .... ._5_r_.-vQ✓I/].- - .4 4--.1 3..__.._'E'%al.0 CENSUS TRACT-------------------------------- <br /> Owner's Name.... ........... .. .� <br /> .....Phane. 35 ZC)...._... <br /> Address { ZC�. --- .Gtan.c .�_�_�C 1�1 CitY- .zi - --. . <br /> a .1 .................. P <br /> Contractor's Name.--f- -,--- t.C'1Y f_j .. cty�s........ .........License #.. � -- F'3_.._Phone---41(Q4'_'_qt`Q ... <br /> Installation will serve; ResidenceApartment House ❑ Commercial ❑ Trailer Court Q� <br /> Motel ❑ Other-__------- ----- ........... <br /> Number of living units:------ ..:......Number of bedrooms-.-...-.....Garbage Grinder------------Lot Size--------_...... -------- .......... .. <br /> Water Supply: Public System and name ................ -------------- ...................... ------------------•-- ------Private ❑ <br /> P ❑ Clay E] ❑ Y y� y Loom E] <br /> Character of soil to a depth <br /> of <br /> Sana SiS'laaX FIII Materaal.. .... .Pelf yes, typend Loam C1a L <br /> (Plot plan, showing size of lot, location of_ssystem 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,) U <br /> PACKAGE TREATMENT ( ] SEPTIC TANK M Size....1_ ._._ "-.----S_X�_----__-..Liquid Depth...:_�r?_—/............. <br /> Capacity.. 1"Y..47v-._TYPe6d Mpterial-Cern-'-.-.------No. Compartments......._ .................A <br /> Distance to nearest: Well__.._ Q.Q... -............___....Foundation_.._ Prop. Line... <br /> LEACHING LINE ] No. of Lines... ------- of each line,...----1+------------ ---- Total Length ......'9-------...................... �. <br /> 'D' Box.-.- Type Filter Material..----.............Depth Filter Material....................----------------..---...................... i <br /> Distance to nearest: Well-----------------i........- Foundation...................... Property Line"----------------.-----.-.---------. t <br /> SEEPAGE PIT [ Depth......LA...._.Diameter. t7%.,A ...Number_._.-_�---------------- Rock Filled YesX No❑ ) <br /> ,r a ++ <br /> X Water Table Depth------------------------- ----- ------------....-•-------Rock Size...._.'7J.;(�-X.LI�-•-- ---•..... <br /> Distance to nearest: Well.----f 00-'r"_----- -------Foundation-...ADD 477.........Prop. Line....l ........ <br /> REPAIR/ADDITION (Prey. Sanitation Permit#--------"--------:--- --------- ---- ------ ---Date--------:--_-.---u-"--..-------------------- <br /> Septic <br /> --.-.---- .---.-.-Septic Tank (Specify Requirements).i.................... ..----..----._.._.r ...".................. <br /> . <br /> Disposal Field {Specify Requirements)....-.. - ^"�..-- 't.� 6./.. -s '[. I <br /> h !vim ........ <br /> d <br /> -. <br /> :..................... ............. ................ . ..... ----------------"--.-...------..... ................. f-- ......_..--- -------- ...................�...( -r l..E��* -� <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with 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 the work for which this permit is issued, I shall not employ any person in such manner as ? <br /> to become subject to1aor m n's Compensation laws of California." <br /> . RR <br /> IS & Son. <br /> In .Si ed.__:. .. .... ...... "-"-----PSTOF <br /> ------ <br /> I <br /> f „ . Owner <br /> B OFICE EOX 1 3p <br /> ---------- - Title- - .5TOCKTON, ....---- -----........P � 93207 <br /> (1f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> .APPLICATION ACCEPTED BY-- DATE ... = lam. ... <br /> DIVISION OF LAND NUMBER-------------- DATE........................ <br /> ADDITIONAL COMMENTS--........... ..r+. ------ ----- ------- <br /> --------"------------- ----------- -- _- <br /> •----------------- ------- --------- .......................... -"----- -- ------ ---------------------------- - -------------- ........ <br /> r --------------------------------------- --------- -- <br /> '" °`�'� <br /> y:.... , <br /> Final lnspecflon b --------"--""----- ------- <br /> Date- <br /> EH 13 24, SAN JOAQUIN LO AL HEALTH DISTRICT F&5 21671 jF /76 3M <br />