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"'FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT G, <br /> ---------------------------- Permit No.----71-- /3 <br /> (Complete in Triplicate) <br /> ------------------------------- -------------- - -- �- 7 <br /> Date Issued_ ,rz ._._-___-_ <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 ADDRESS/LOCATION--------.-, ;Li'ZU W--- R - r-r-O/�T �l --_.CENSUS TRACT------ ------------------- <br /> ------------- <br /> ----------------t - <br /> Owner's Name- 1�� 1�5_f ; - Phone = <br /> Address- = � ] --- ------�-- ------ --- ---- - -------------------- ---. -City-T�14� Zip <br /> O-- 4 ------------- <br /> Contractor's Name_. l �-L.� - JJ ----- --- ------------------ :---- :License # 1.�' �-----Phone_$ ur <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court , <br /> I . <br /> --------------------------------------- <br /> � <br /> Water Su living units:_--,I-.-._-__--Number of bedrooms -----Garbage Grinder Lot Size- ----.�- - <br /> Number.of_1 : ; r _ -f i_Priva#e <br /> Supply: Public System and name -- :------- - --- -------- <br /> Character of soil to a depth of 3 feet: , Sand ❑ ?Silt ElYClay,❑ Peat 0 Sandy Loam L_ Clay Loam ] { <br /> E <br /> ( Hardpan.0. Adobe❑ Fill Material-.- . ---.Ifi* es, type---------- <br /> ---------------- -i <br /> (Plot plan, showing size of lot, location of system in relation to'wells`, buildings,;etc. must be;placed on reverse side.) r <br /> NEW INSTALLATION (No septic tank or seepage pit permitted if public sewer is available within 200 fe ,t,) �/ 9 <br /> PACKAGE TREATMENT [ ] SEPTIC TAN y <br /> K.. ['] . . , • Size==;;� �� x - Liquid Q pth b. = 0 <br /> ' Capacity-/� =------ TypeIP± __ WMa rial� d ...........No. artments,---- --- '��------- <br /> Distance to nearest: Wella..=__ _( ' _._s--_----__ , ; -Foun ation.-_._ (J-.-_-.-_ - -- rop:�line b --- -`- <br /> LEACHING LINE [ ] No. of Lines_ 3-_____......:.....:.Length of each!line_.�__.._-__._.____.__-Total Length.--,�,�4--_ __ <br /> - �l. <br /> Q Box J._. _-Type Filter MateriaDepth Filter Material_ ------ A(_____ -------------- <br /> ------------ <br /> ---- ---- <br /> Distance`to nearest. WeIL /( :_' Foundation__ ' Property Linei_-67 <br /> SEEPAGE PIT [ ] Depth -_. '�' -- ° Rock Filled Yes ❑ No❑ <br /> Diameter : ._.__._. Numbed.' <br /> I Water Table Depth--- ------------------ ---- --=---- Rock' <br /> ---------------------------'------'------------- <br /> c� <br /> ��` , <br /> - <br /> Distance to nearest:Wel!-_.------ _.____-._________ Foundation__'___________________ _ __Prop, Line--------_.----------------- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-------------------------------------'- :� - *"y'uate ----.--- -_"-:----- ------------) <br /> Septic Tank'(Specify,Requ.ir-cm�tsl- ...__ - ------ --_ ------------- ----------------------------- ---- <br /> + <br /> Disposal Field (Specify Requirement's) ----------- • - I; - :-- --=---- -- E ' <br /> � ,t <br /> ' <br /> - ------- <br /> -------------------------------------------------------------------------- ---- - ------ - <br /> " (Draw existing and required add ition'on r-ev"rse e) <br /> I hereby certify that'i havwprepared;this application and That the work will-b4 done-* accordance with Sate Joaquin County <br /> Ordinances, State Laws, and Rulwand Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: - r t <br /> "I certify that in the 'performance of'fhe work for which this permit is issued, I shall not 4Mploy any person in'such manneras <br /> to beeccome subject to orkracip s ompensation:.Iaws of .California.." <br /> t <br /> --- -------- Owner <br /> -=- i--- -_------ 4.._.. � .-Title-- --- - <br /> if other than owner <br /> FOR'-DEPA1tTMENT-USE-ONLY . <br /> APPLICATION ACCEPTED BY`' - _ --- -------- DATE --------- <br /> L <br /> DIVISION OF LAND NUMBER!'-------------- -- -- --------------------------------------------------` �ti�+�� Z1�� Jia --'- --DATE -- s �: <br /> ADDITIONALCOMMENTS- ----------'-------=-- - ----- -------- ------ ------------------ ------- ------=------_------------------------------------------------------ --- <br /> i -------------------- ----•------------------------------ <br /> i ----- --- ----------------------------------- <br /> ---- ------ ------ = <br /> k ., a-. I, .. - ' --------------------- --- - ------- -- ----------- :---- <br /> - -- <br /> Final Inspection by: - IL--`- ------------- ­------- --=-------- - ==� Date. 1 =----=---- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S D677 REV. 7/76 3M <br />