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FOR OFFICE USE:. FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -------- <br /> (Complete in Triplicate) Permit No. . <br /> ............ ...................... -: Date Issued.&_*.:7_:�Q • r--� --------- - This Permit Expires 1 Year From Date,Issued' <br /> Application is hereby made to.the San Joaquin Local Health District fora permit to construct and.instoli the work herein described. <br /> This application is made in compliance with County.Ordi nce No. 549 d existing Rules and Regulations; <br /> q <br /> JOB ADDRESS/LOCATION -- -- -•--.f I. klUWSUS TRACT--------------------,......._... <br /> .. --- '` <br /> Owner's-Name.- <br /> _. <br /> ----- .--- :. <br /> ---- <br /> �W� ..�.Y-- / _• # rTL... -.3. <br /> �fn. ._._ iess. . .. . . .... <br /> Contractor's Name_ License Ph <br /> �one- <br /> ._?. <br /> Installation will serve; Residence Apartment-House ❑ - Commercial .0 Trailer Court ❑ <br /> Motel ❑ Other .......... ..... �. <br /> .. <br /> n�z_/.2�. - _ <br /> Number of living units:... --- _.Number of bedrooms...',�Garbage Grindew•__II..._�...Lot Size.----- IM. _._.._. __ _ _ <br /> Water Supply: Public System and name..__C�i.4...Gv.�,+�V&...... ....... ❑ <br /> ---...--.---- - - <br /> --- ----------------.-..--.. - ......---•-------._Private , <br /> Character of soil to a depth of 3 feet: Sand,E]. . Silt❑ Clay ❑ peat ❑ Sandy Loam ❑ Clay Loam lr <br /> Hardpan E] Adobe Fill Material - .... ...If yes, type_..-__.-_-------- ------- <br /> (Plot plan, shays>ing size of lot, loco i of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTAL'L'ATION: (No septic tank oriseepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE T'R'EATMENT T 't <br /> ( ) SEPTIC TANfC,.�. S' e-_........ Liquid Depth..-� -------------- 1 <br /> ---...Type-- 1 - Material. No. Compartments...-_ .. �. <br /> - ' Distpnce to.".nearest: Well __.._..."_ . ,... ._....... .....Foundation--------/0PropLine_.: <br /> 9.7....... <br /> LEACHING LINE Na. of Lines .._...�.___._..._ g <br /> ..._..Length of each fine ...... . .:............. Total Length _._.AV------- _._...... ...... <br /> D'-Box_`..__ Type Filter Material.l5-$ ."Depth Filter Material !_�°G�:.._.......................... <br /> Distance'to nearest: Well---- ------------------Foundation.-._-.-_ ._. _.T.4•._____.Property Line_�� �. <br /> _ r <br /> SEEPAGE PIT Depth--Zd._,...Diameter...3.00 ---------/----------------- Rock Filled Yes K No <br /> r <br /> De <br /> Water Table Depth----------------------- ------- -- ---------- Rack Size__.': ` <br /> P ��.. <br /> Distance to nearest: Well.-----------------................._- Foundation_.....". ,; ....... prop, Line._..... ........ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.........:....... ......-_._ . _...--------.Date_-.--_-•--..................._...--------:..._) <br /> Septic Tank (Specify Requirementsl- `---------- <br /> Disposal Field (Specify Requirements)__........._......_ .............- - <br /> --- --.....i.-------.... . `}--------- -------- - ----- -- ----------- ------------------ -- <br /> -------------- ---- - , <br /> - - - ------ ------------- .................... <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 iii%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: 1 i <br /> "I certifythat th <br /> at in e performance of the work for which this permit is Issued, I shall-not empla.y�any person in such manner as } <br /> to become subject to Workman's.Compensation laws of California," <br /> Signed.-- --- . ..... •- -- Owner s � <br /> By------------ ........ -- - - --- ' --- Title ------------------------ }. <br /> ( other than owner) <br /> r R PARTM T USE ONLY <br /> _.. —� jF w <br /> APPLICATION ACCEPT D BY-----= . ... . . _ �~ t , .. :.... -.:4...DATE .--- -- II 7 <br /> DIVISION OF LAND NUMBER............... ......... ----- - <br /> . DATE. - <br /> -- .. . . <br /> . <br /> ADDITIONAL COMMENTS....--- ....". . z ...... <br /> . �. .. , <br /> - - ­­­ ... <br /> ----- <br /> ----- --- -- ------------ <br /> Final 1nsRett�on by:.. _... . --------- ---- ------------- ©ate / °� - ` <br /> Elm! 13 24 SAN JOAQ N LOCAL HEALTH DISTRICT Fes 2:677 Rf <br />