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"N ta FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT - <br /> . .S?�.o.... 8' <br />.................................................... . Permit Na22(Complete In Trlpllcoto) , <br />....................................................... This Permit Expires Year r E S..2.7From Date issued Date lssued?-= . t`` <br />._... . . ..---•............ ... .. . . t <br /> Application Is hereby evade to the San Joaquin Local Health District for a permit to constrict and install the work herein <br /> described. This application is made In compliance with County{ Ordinance No. 544 and existing Rules and Regulationss <br /> JOB ADDRESSAOCATION ..... .f. .... �. l f ' . '.f� , ..A.QCENSUS TRACT ......................... <br /> Owner's Name ..... . ..t......o-.,. ... . ... ....Phone ....:.............................. <br /> Address ...... ��.. �1 �-- ..,/ �._..City .PCr'�G4 .._ ........... <br /> Contractor's Name ... ,,�.. .--• �..-��J.,�Pi�t-�.,Au),LIcense #CZ�.,�/.�17Phone <br /> � <br /> Installation will serves Residence Apartment House t] Commercial OTrallw Court ] <br /> Motel❑Other................................................ f <br /> Number of living unitst. . .... Number of ms . .Garbage Gri der .. Lot Sl ... . ..7:z.....�.-- <br /> Water Supply: Public System and name ...�. � ... . -------- -.............................:...............Private <br /> Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay p Peat p Sandy Loam Q day foam❑ <br /> Hard pa Adobe❑ Fill Material ............If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must. be placed on reverse tide.) <br /> NEW INSTALLATIONt (No septic tank or seepage pItpermItW if public sewer is available within 2Cd feet,) <br /> IV 6 F <br /> PACKAGE TREATMENT ( ] SEPTIC TANK ....................... <br /> .............:........... Liquid Depth .:......................., <br /> Capacity .................... Type .................... Material...................... No. Compartments ...................... <br /> I jN <br /> Distance to nearests Well. ..................... ... <br /> . ...........Foundation ...................... Prop.-Line .......... .......p <br /> LEACHING LINE No. of Lines ..... .. .. ........ Length of fl e.... �.�.. ....... Total Length .ewe Qr............0''"f <br /> 'D' Box .: .- Type filter Material ..Depth Filter Material .15711................................. <br /> Distance to nearest: Well-..,45­42. ......... Foundation ./.V............... Property Line .....4—....... <br /> r .r.j <br /> SEEPAGE PIT Depth .�....... Diameter Number ....... .................... Rock Filled Yet,(j( No 130 <br /> Water Table Depth ........��.5F.,02 �......................Rock Size ... ...................... <br /> Distance to nearest: Well ...... . ...................Foundation .. 1 .......... Prop. Line ......... <br /> ........ <br /> REPAIR/ADDITION(Prov. Sanitation Permit# .7QQY_:l9V.r; • : .R:7•1.. Date .............. ....:..,.---• - <br /> Septic Tank (Specify Requirements) ..............7. !fY S 3 .... .. ..... ...��.•.. i.......�.....,..�fI ............. <br /> Disposal Field (Specify Requirementsl - - . 0 •.... `�`.-..... 1r ............. i3 <br /> ......................................................... ._ ........ .......................................................... <br /> .;A <br /> .........-•-•...........................................................•....................................-_.................................................................._..._................... <br /> (Draw existing and required addition on'reverse sidel <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licew <br /> sed agents signature certifies the following: <br /> "I certify that in the peifor'ma`nce of the work for which this permit Is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California.". XtARENCE'S SEPTIC & SEWER SERVICE <br /> Signed .. .. Owner 263 So, Oro �L Stockton, Cali#. 95205 <br /> M40-3209 Contractor's Lic, 26717 <br /> yitle .......:.............. <br /> (lf other than own <br /> FOR D !NEN USI: ONLY <br /> APPLICATION ACCEPTED . .. rT X.... DATE .... .'- .....��...... ......: <br /> BUILDING PERMIT ISSUED .......................... ........................ ----. ..-. .......... .---- DATE ................. <br /> ADDITIONAL COMMENTS .............................................................................. ...__................................... <br /> ............................ <br /> ........... <br /> ........... ................ ................... ..........----... ...... .....................-•----........................... �..... <br /> ...... . . .. ................... <br /> ................................. .........-....- ..-.. --- ... ............................................ ...kyr ..................... <br /> FinalInspection by: .......................� � .... ......................-- ..............----.......................Date .. ..;v. ..../.L......-...-............ <br /> Eli 13 24 1-613 Rev. 5m SA JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />