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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7 7_ �9 ,J <br /> --------------------------------- (Complete in Triplicate) <br /> Permit No------ ----- -------Z- <br /> Date Issued__14-_.__.__._.__ <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.............5 o 0 ------- -5 <br /> -5 _.._7 !'ll.l U CENSUS TRACT <br /> Owner's Name--------- 11t_E lQh1-------------- <br /> = .._Pho _-=6R3-----J�-_�--�/-._ <br /> ., <br /> --� s 33 fi <br /> Address------------=------- _ G----- - -----------=------------=--------------Ci --------q Zi <br /> Contractor's Name nn �; rU�L =CneLicense #_a � .. <br /> /'�F -------Phone PA64/0 <br /> Installation will serve: Residence TR . Apartment House ❑ Commercial ❑ Trailer Court_ ❑ <br /> Number of living units_______ ________ Number of bedrooms---3..:.__Garbe a Grinder___._:_. __Lot <br /> • .,:._._ =,. .,.. Motel �< Other---•=------------------------- ---------- <br /> Number <br /> --- -- - <br /> t <br /> g - .—_g. _Size-------------- = ------------•-----�- -- <br /> Water Supply: Public System and'name-----------------:------ ---------- ---- ---------------------------------------------------i------------ '----- -------Private <br /> Character of soil to a depth of 3 feet.Safe Silt.❑ Clay E] Peat ❑ Sandy Loam Clay Loam 0 <br /> Hardpan Q Adobe Ell�lf Material.---____--'_If yes, type--- ------=------------- -- ---- <br /> (Plot plpn, 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' [ ]" f-SEPTIC TANK [ ]' Size----------------� -----------------------{----Liquid Depth.___.____._ <br /> Ca pocity = = TYPe-----------------------Material------ ---No. Compartments- ____________________------- <br /> e <br /> ► d : _... . nceo nearest: Well : .Dista -=------iFoundation------ -------- ---------Prop. Line—__ = --• ------'--- <br /> LEACHING LINE [`] No. of Lines- -----___________________Length of each line._9; ------------------ Total: <br /> I } Length._____._______________-, <br /> -------------#-- <br /> D' Box-------_---.Type Filter Material'-------- De;th Filter Material--- <br /> ---------------------------------------------------- ----- -- <br /> Distances <br /> Distance to nearest: Well-:-'------------------------Foundation------------------------------Property Line----------------------------------_ <br /> SEEPAGE PIT [ ] Depth----:------------Diameter-------- -------Nurriber-------__ ____ Rock Filled -Yes E] No El <br /> Wbter Table Depth----------------------gg-------�y-----------------`------------Rock Size. '---------------------------------------- <br /> Distance#o nearest: Well--------------------------------------------Foundation--_---- - --.._'_.Prop. Line---------------------------- <br /> I [ ► l � �, <br /> REPAIR/ADDITION {PrevrSanitatio' Permit#_______________ _'}+______#______________!__:!__.Date----------------------------------- <br /> ,i! s _ <br /> Septic Tank (Specify Requirements)-= t -- ,- _ - - z <br /> t � � ' f�E <br /> �j► G <br /> Disposal Field (Specify Requirements) L r91 = = L � ---------- ------------------ f <br /> [ � ,-- --- ----- � <br /> ----------------------------------- <br /> a ----------------------------------------------------------------------- <br /> ; <br /> # 1 " (Draw existing arid'required addition on reverse side) <br /> I hereby certify that�_have_:prepared�this-opp ic1 ation_and•that-the--work--w ll-�be done in accordance with -San Joaquin County <br /> Ordinances, State Laws; and Rules_and Regulations of thet San-Joaquin Local•Health District. Home owner or licensed agents <br /> signature certifies the following: ' L <br /> t I - 7 <br /> "I certify thavin the performance oCthe work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject.toor an!s .Compensdtion;laws .of California"�.-_��.. v <br /> Signed- -.----. ------ -.- --------- <br /> _ _. _ :Owner <br /> BY-�------ ------=------= ---------------------------------.- - -- '.Title - --- -- --------------- ------ . . . t <br /> +_. <br /> L___(l other th owne`r] t ; <br /> u - <br /> DEPARTMENT USE ONLY` � <br /> APPLICATION ACCEPTED BY ------=t ----=-------- ------ ----._D ,TE.s___ --:�� ---------------------------- <br /> ----------------DIVISION OF LAND NUMBER_ = ------------------------ DATE------------------------------------------------- <br /> ----------__-._ <br /> ADDITIONAL COMMENTS---------------------- - -------- - --- --------- ------------ ---------------------------------------------- <br /> ------------=---------------------------=------------=----- --------- ---- <br /> ------------------------------------------------ ----m - ---------- --------------------------------------------~----------------- ------------------------- --- - ---- - -- ----------- <br /> w.. // <br /> Final Inspection b " " = = ��. _ Date-- _l-- <br /> EH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677Qev,� ann <br />