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FOR OFFICE USE: FOR OFFICE USE: <br /> Jr�i`� _ Il APPLICATION FOR SANITATION PERMIT <br /> F (Complete in'Triplicate) Permit No._.7 -.j, <br /> --------------- -----------5331 --�-- - <br /> Date Issued.-/y.�_�� <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 Count Ordinance No'-544 and existing Rules and Regulations. —— <br /> JOB ADDRESS/LOCATIOIy,� __. , -r 4 ;42 _ _ RACT <br /> ----------- <br /> €`f <br /> Owner's Name- ------ - ' y _ .x.1' Ph .' _.:. .� <br /> � �--- - _ one <br /> Address ,- �_-.z. i y � <br /> i <br /> `"^ <br /> C t � � .�.7 <br /> Contractor's Namet '�� .tl -, -. Y °r'i ..fit Z �� <br /> . +` ;mac` * ' License: <br /> Phone IP <br /> InstallationEwill serve; �esldence Apartment House ❑'• Commercial - Trailer-Court-E­ <br /> f Motel,❑ Other---------------------- <br /> i <br /> Number of,living units:__ �f�. Number of.laedrooms '�'' - Garbag Gnn'der-` � - "Lot Size <br /> r , •�' �:�h-4-,, y�,rt n t�. � yam. � � F _ -_--- ---� _,�-. - ------- ,�--- <br /> Water Supply: Public System and na'nie <br /> -.�._ , •�.�...x -- -= t ti `.-_Private' <br /> Character of soil to a depth of 3 feet: - Sand ❑ Silt❑ Clay''❑ Peat-E]—Sandy Loam ❑ Clay Loam <br /> Hardpan n-*-Ad6be*V]�Fill-Material-'r'� �"' " � "•`�— <br /> rr �i If Yes, type ----- ------ n <br /> i V ( <br /> (Plot;plan, showing size of lot, location of system 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,) �;,. �. <br /> PACKAGE TREATMENT j ] SEPTIC TANK Size_a �---_-�- _A� �:____'_ Liquid Depth.. -`---------Tr <br /> -- r <br /> A f <br /> # Capacity./I----- Type, _: 5� r Material C No. Compartments :--r l + <br /> } Distance:to nearest: Well_.._ '.*.-------------- ------- Foundation--- ----------------Prop. Line-,= € <br /> -------------- <br /> LEACHING LINE Na, of,Lines-.--- -----------------!.___Length of each <br /> y _ line.--.-- - _- ------_ ___ ____. , l Length­- <br /> -D'D' Bx Material l �M _:-- _ <br /> --------------------- _------------- -_ <br /> Distances to nearest: Well. ----__----------- Foundation �.----._______-Property Line--- ------------------------- <br /> U3 _ _t___ <br /> or <br /> /•�P vel �s' -----Diameter- -----_--.-Number_-_ ,_-------=------------ - - Rock Filled Yes No <br /> SEEPAGE PIT Depth <br /> . t' <br /> 1 <br /> Water Table;Depth r ------=--------------------------------Rock Size---- ' ----- --------- <br /> 16167 r +' <br /> 00 <br /> Distance to nearest: Well .---I--------------------=Foundation.______ v ` _ <br /> ----.Prop. Line.•-------------------- <br /> REPAIR/ADDITION <br /> --- ----- —•r <br /> REPAIR/ADDITION (Prev.-Sanitation Permit#-----------------------_------------------- ------Date----------------------------------------------) <br /> Septic Tank (Specify Requirements)------------------- --- ----------------------- ---------------------------------------- <br /> ------------------------------------------ <br /> --- <br /> i <br /> Disposal Field (Specify Requirements)- --------------------- ---------- ------- ------------------------------------:--------------------- - ` <br /> ---------------- <br /> 14 <br /> ------------------------- .A <br /> ------------------------------------------------------------- <br /> --------------------------------------=------------ --------m---------------------------------------:---------------------------------------- _ AA <br /> _ ---------------------- '-- <br /> f (Draw existing and required addition on reverse side) " . - <br /> r <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 rt <br /> signature certifies the following: ; *, <br /> "I certify that in the performance of the work fo; which this � erniit is issued I shall not employ an l f <br /> p , � p y y person in such.manner as <br /> to become-subject to Workman's Compensation laws.of California." <br /> Signet'd-------- _ -f <br /> Owner <br /> . J SEWER 51RV <br /> --------- -- TIC----BY - �P _, '] <br /> s` (If other than owner) . 263 So. Oro Stockton, Calif. 95205 <br /> Ph.463.3209 Contractor'S UC.RVLIZA <br /> FOR DEPARTMENT USE ONLY � ' <br /> APPLICATION ACCEPTED-BY ---- - ---- : ------------------------------:- ---------------------------------DATE. //�7 -�' 77 <br /> DIVISION OF LAND NUMBER._ -- --- ------------------ --=----------------- ---DATE------- -- <br /> �y 7 7 G <br /> { <br /> ADDITIONAL C MMENT � .---- ---- -,��- �- ------�f`�1�-- -•`---------- ------- - --- --- <br /> t <br /> - ----------------- v i <br /> =-- p - -------=------- -- = 1 <br /> Final lns ection 1b — �.-- -- - 4 <br /> s - <br /> _. -Date----- - -------- ---- <br /> ��- /� , <br /> EH 13 24 - SAN.JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7/76 3M <br />