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FOR OFFICE USE: _ FOR OFFICE USE: <br /> APPLICATION FOR'SANITpirl0N PERMIT <br /> ---------------------------- <br /> ' {Complete•in'Triplicate) --^� � � Permit No...-. _��_.___--_- <br /> Date <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 /> ... -/ ION---.� �/ .. _.�-^ __-VOL_-�— .�.—." .CENSUS TRACT-e--g-----�------�- <br /> (p <br /> JOB ADDRESS LO . <br /> � <br /> i Owner's Name '- ------------- ----------- ---- --- - -----------------Phone----------- ----------------------- <br /> s <br /> ' Address °Z 5 '- - ---------- F <br /> � _ ----- ---- ----- ----------------------- ------------ ---- <br /> Contractor's Name--'--+-_-} ",� --- --- _ ice 7/ ` � Phan �J`_�`/� <br /> '�"License �• e------ �' <br /> Installation will serve: ] ------------------ <br /> Residence ❑ Apartment House.❑ CommercialTrailer Court ❑ , <br /> r M motel [] Other:. a - .... .:. ._ . <br /> ----- --- s ! <br /> Number of.liv.ing units:--------77 Number of.bedrooms:_.____._._ GarbageGrinder . .__.:__Lot'Sizs - ______________________ <br /> Water Supply: Public System and name ------ 'w -'� = i - Private ❑ <br /> Character of soil to a depth of 3 feet: Sand Silt Clay ❑ y Pe:t❑; S nay Loam ❑ Clay Loam ❑ <br /> i Hardpan ❑ Adobe�FTII Material y typ ----------------------------- i <br /> If es, e_._ <br /> (Plot plan, showing size of lot,-location of;system in relation to'wells, buildings,'etc. must be placed on reverse side.) <br /> �.., A.....,E � <br /> NEW INSTALLATION: (N6septictank or seepage pit permitted if public_ sewer is available within 200 feet,) <br /> PACKAGE TREATMENT t -�^'-'�"'""� � "` � `�-- ! <br /> [ ] : SEPTIC TANK'' [ n Size ------------ L'iquid'Depth " <br /> off` <br /> CapacityOO_----:Type- �' --Matarial._ �_ � No. Compartments------------------- --------------- <br /> Distance to <br /> --------------Distance.to nearest: Well.. _'_____________ --.Foundation.-'/ -----_-_---------Prop. Line--- <br /> P/ +.+ <br /> NG LINE; ["J' No. of Lines-`-- -: - ; <br /> ------,--.- -..::.-:Length of each line-- '�d------- '-----.Total Length------ - <br /> l <br /> [ "D' Box------------Type Filter Material_5� � .Depth Filter Material---------- <br /> .._ . r ..- Distance to nearest: WeIL_". .. . ., :., .. r - --,�------------ � -�---------- h <br /> #, -._ Foundation I--------------------Property Line S -- ------------ <br /> SEEPAGE'PIT [L]' Depth_ S� D.iameter__ ____________Number___.___--- Rock Filled Yes Nor <br /> . <br /> Distance <br /> Table 6'a th. ------ - Rock Sizer.�?�--------- ---- -------------------- <br /> Z" <br /> ---- ---- ��! t <br /> _ Wat <br /> to nearest: Well._.:.__. PJ '- - - -. _Foundation__ .__ice �---------prop. L'rne.__.S_-__:_._____-__'-.. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-------:----- ------ ---- - ----=4 __:_"--------Date.-_._b '._-_-____--_-_______.___--_--- <br /> Septic Tank (Specify Requirements)------------------------------------ <br /> -------------------- -== = =` .:-a_- -` ' _ <br /> 4 <br /> ` ---- <br /> Disposal Field (Specify Requirements)= -----=- ---- i------ -------------------------------------------------------------------- <br /> ---------------------------------------------------------- <br /> --------------------------------- ----------------- -------=---------------------- <br /> --- ---- ----- <br /> (Draw existing and required addition on reverse side) 4 r <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> r 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 /> "1 certify that in the perform-ante of the work for which this permit is'Tissued, 1 shall not employ any person in such manner as <br /> Signed- -f ._ G '�----- . <br /> to become ub'ect to Workman's Compensation- laws.of California.' t <br /> g � �` ------------------- <br /> By <br /> --.--- - <br /> By------- .- '� -Title <br /> ------- - ---- ----------------- <br /> (If other than owner) <br /> OR D&PARTMENT USE ONLY ,; <br /> APPLICATION ACCEPTED BY------- --- - ----------- ------- <br /> ------------ ---------------------------------------------------DATE. - = e <br /> - <br /> DIVISION OF LAND NUMBER----- - -- - ------------------- - ------------------------ ---DATE.< <br /> ADDITIONAL COMMENTS_ <br /> =-------------------------------------- ------------------------------------------ <br /> ----- -=----------- ------------------------ --------------- ------------ -------- --------------- <br /> -----F--------------------------------------- ----- <br /> ----------------------------------- <br /> --- ----___-__•__..--- <br /> ------------- --------- - ---. ._ .- ------- <br /> Final inspection by:-- -------.--- - - ---�' ---=--- ---------------------- -------------------------- <br /> ------- <br /> -----=- -- -= '-=-'----Date------� /F& 2 <br /> EH 13 24 AN JOAQUIN LOCAL HEALTH DISTRICT 577 <br />