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'.�'" �.;' ..-..� - ••—,may.-��.a. .,, �...,�„ _ �• <br /> FOR OFFICE USE;:7� FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------------------------------- <br /> (Complete in Triplicate) Permit No. 3� ' <br /> -------- ------------------- ---- -------------------- <br /> Date Issued�4 3_77.I - <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.AQDRESS/L.C►CATION• T ,- - -R l �%�,a -�_, fes_. ..R.CENSUS TRACT_ ....... <br /> = Owner's Name-=---,6?_1* <br /> ---------------�-J-------------}--�-�---------------------------------------------- <br /> Phone <br /> Address - tYi '7/iC.�4-_---- ------Zip- --- <br /> a j_.. 1 — <br /> /J <br /> Contractor's Name-_-__ v` � ' <br /> � - ------------ License <br /> Installation will"serve: Re <br /> s <br /> i <br /> d <br /> ence ❑� Apartment Ho'se.❑ ' Commercial ❑ Trailer Court ❑ <br /> M at <br /> e I <br /> Number of living units----- -----------Number o bedrooms-a---Garbage Grinder_ <br /> ' ----. _«__..:_.Lot Size-- -=-------------------- -- <br /> Water Supply: Public System and name- -- ---------------------------m----- =.__ - _ Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt_❑ Clay ❑ ; Peat 0 Sandy Loam Clay Loam ❑ ' <br /> Hardpan Adobe w-.__._r_�_ <br /> p ❑ ❑ '�FiII�MateriaC�._:.__._If yes, type----------------________.___--- <br /> s <br /> (Plot plan, showing size of lot, location of system in relctionfo wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: (No-septic tank or seepage pit perniitt,edsif public sewer is available within 200 feet,] + <br /> PACKAGE TREATMENT SEPTIC TANK ; ` <br /> ] '(..]. I Size I e Liquid Depth------------------------ -A�; <br /> Capacity------ - ------------ <br /> -------- ;Type----------= =----------Material----------- '----_No. Compartments------ ------- -------------------- <1 <br /> E _ <br /> 3 <br /> Distance to nearest:Wella :,._..:Y. _ .;-�__ ,.___,=-=�_:,,------Foundation--------------------------Prop. Line------.---------------- <br /> LEACHING <br /> ------ ---- .LEACHING LINE' { ] No;of"Lilies- i_..._�'.Le gth of a h line .. -: n._yy ' '.Total, Length --------------------------------_ '__ <br /> D' px------------Type Filter Material-------- ------ -Depth Filter Material.--------e-----------------------------------------.------ ---- <br /> Distanceto near.est:-WeIL•_---_--------------- <br /> - Foundation------------------------i.--..Property Line--------------------------------__ <br /> t <br /> SEEPAGE PIT [ ] Depth-'..__ --- .Diameter__ - -___ Number_________________________._____ Rock Filled Yes.❑ No ❑ ' <br /> Water Table,Depth---�-<-• ---------------- ---------------------Rock Size---- `----- <br /> f � , <br /> s Distance to nearest: Well--------------- -- -- --------------------Foundation---------:._._..----------Prop. Line---------------------_-`- <br /> REPAIR/ADDITION {Prev. Sanitation Permif#---------------------.----------------_-------- ---Date---.------------- :------�_----.------.------1 <br /> s i4C'f{ r _ --- .--------- ---- ------------ -------- ------------------- -------a------ --------- <br /> Septic Tank (Specify Requirements)- ------ --------- - -- -- - - - -------- <br /> Disposal Field {Specify Requirerrkenfisl------f.G�' �-,tai r------------------�ts °{ ¢ ---�-''fix---� � <br /> r i <br /> tAf - E <br /> ---- ------------------- -- ---------°-------------=---------= -------------- ----------- - ------------------------- ------ <br /> t }(C�raw'existing and required addition-on reverse side) c } <br /> r 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 performarice of.the work-for which this permit is issued, I shall not employ any person in such manner as <br /> to become.subiect t onkman's penscition: laws of California." <br /> s <br /> ------------------Owner 3 <br /> By-,------ ----------- -----------=----------------------- .. ---- Title----- ------------=------ ----------- F ------------ -------------------- <br /> + (If other than owner) _ <br /> FOR-DEPARTMENT USE-ONLY_.�..... _....... '.-. .-- - �..� <br /> APPLICATION ACCEPTED BY---------: i ----------------------- ------------------- <br /> ----------- <br /> DIVISION <br /> ------------ <br /> DIVISION OF LAND NUMBER- ----------- - �-�; , - _�-----------?� -------DATE-------------------=-- --------- ------- <br /> ADDITIONAL COMMENTS------------- `� --------- -------- ------------ <br /> T ----------------- -------------------------------=-:"-----_------------------------------ --- = - - <br /> -------------------- <br /> ----------I------------------= --------------- --------- --------------------------•--------------------- - ------- --------------------------------- ---------------- --------------- ------------- <br /> _s ---- ---------- ---------------- ------- ---------- =------------------ --------------------------------- ------------------------ <br /> Final Inspection by:--------------------------- -------------------------------------------------- _Date. <br /> EH 13 24 61, SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/7ti 3M <br />