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FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No7_F-7_f_S__ . x <br /> (Complete in Triplicate) <br /> ------------------------------- - - <br /> --- --------- --- Date Issued--- -7� -t <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 /> compliant <br /> This appli on is made in with County Ordinance No549 and existing Rules and Regulations: <br /> �11 <br /> - ------- <br /> JOB ADDRESS/LOCAT3 Phone_ _ <br /> i 1 . CENSUS TRACT... <br /> Name-- --- -- � - ----��-------------- --------- p----- - -- ----------- <br /> Owner's __ <br /> -------- LGCP 1�!_�_ ? ------ -----City COY- ------------------ZiP---- ------- ----/ <br /> 1_.�- <br /> Phone_J - Ly ------ <br /> �� �? N-l__f��'+ri._!�I_t`!._. License #. <br /> Contractor's Name-- --------- -- -- `� - -- <br /> b <br /> Installation-will serve: Residence ❑ Apartment House.�] Commercial ®!Trailer Court ❑ <br /> Motel ❑ Other------- ---------------------------------------- <br /> --- <br /> ---=----------=-- -----------=----- <br /> -------------- <br /> Number of living units:_..°__. ----_Number of bedrooms___.: Garbage Grinder--- --.Lot.Size..___.._. <br /> - <br /> ----Private <br /> Water Supply: Public System and name-------------------- ---------- ------- -- ----------------------------------------- ------ - <br /> Character of soil to a depth of 3 feet. Sand ❑ 't ❑ Clay ❑ Peat❑ Sandy Loam ElClay Loam ❑ <br /> r t Hardpan ❑ Adobe - Fil1 Material_.__- If yes, type.__, <br /> ' <br /> ------- ------= <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc. must be placed on reverse side.) - ��- <br /> Ry <br /> NEW INSTALLATION- a.(No""septic"tank .or seepage pit permitted if public sewer is available within 200 feet,) <br /> F <br /> PACKAGE TREATMENT [- ] ."SEPTIC TANK [ 1 Size-------------------'------------------------ ---------- Liquid Dept ._---------------------- <br /> Capacity---- _----------- Type- - Material - -- N No. Compartments---------,---------- <br /> Distance'to riearest: Well_=-...z -` - -------------Foundation---.--ep------------ <br /> Prop. Line-------)--------------- <br /> r <br /> t <br /> LEACHING LINE. [ ]. No. of,Lines.-.-_---;L ---Length of each lino._____.`)-?---------- ----Total Lengthy___.:_____-_ _d-- <br /> 'D' Box--,-.-/ -Type Filter Material-1,,_--�-r����epth Filter Mate <br /> ------------ <br /> - ------------------- <br /> --.-------- - <br /> iWell :-- Properyine_ ?- -------------- <br /> Distanceto nearest: -_-.-� P-QFoundation-- Q w <br /> SEEPAGE PIT [ ] p Rock Filled Yes ❑ No ❑ <br /> De th_ --Diameter ------------- -----Number -- ----------- <br /> WaterTable'Depth--------- ----------------------------------------- <br /> ---- <br /> Rock Size.-- - <br /> Distance to nearest: Well-------- --------- <br /> REPAIR/ADDITION <br /> - -- <br /> ---- -Foundation--,--------"------------- Prop. Line--------------------------- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------------------- - <br /> '------"Date-------------- --------- -------- -------} <br /> - -------------- - - ------- <br /> Septic Tank (Specify"Requirements)------------- ---- <br /> ----------------- <br /> Dis4posal Field (Specify Requirements)--------------:------- -------------- <br /> - <br /> - -.------------------------------------------------------- ---- .. _------ --------- ------ <br /> - ---- -------------- <br /> --- ---------=-----------------------=----- `--------------------- _ -- - <br /> (Draw existing and required addition on reverse side) <br /> 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 <br /> certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> r, <br /> to become sub' jWkman's Compen ion .laws of California." -- <br /> Owner <br /> Signed - <br /> ---- <br /> ` ,,. Title <br /> ----------- <br /> __{!f ------- <br /> - f <br /> other than owner} <br /> :. F DE MENT USE ONLY' <br /> APPLICATION ACCEPTED BY-.--. - -- ---------- <br /> DATE <br /> ` ----- ----------- --- <br /> DIVISION OF LAND NUMBER------=--------------------- -- --=-------= ----------------------------- ------------------=- DATE._ <br /> ----------------£ <br /> I <br /> ADDITIONAL COMMENTS - <br /> ---------------- --------- <br /> ---------------------------- ----------------------------------------------- <br /> 4 ------------•---------------------- <br /> _ ------------------- <br /> a <br /> ____._.__.___._-.- <br /> -_ <br /> ate -�----------- � �-- ----------- <br /> -------- <br /> --- -----"/ ------------7-�-�-�- -------- --- ---- <br /> ---- <br /> Final Inspection bY:------= - <br /> F&5 2V. 7/76 3M <br /> ! <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT d� <br />