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FOR OFFICE USE-_f FOR OFFICE SE: <br /> • APPLICATION FOR-SANITATION PERMIT r� <br /> /) ` (Complete in Triplicate) Permit No..7".1k)) <br /> Date Issued-.S/ 6J <br /> ....................................... This Permit Expires 1 Year From Dale 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 <br /> ��Cjjo__unt (p/gdinance No. 549 nd existing Rules an egul tions: <br /> ut <br /> 'JOB ADDRESS/LOC TION.. ./ '......lfR+ ?�.yi� .. ... ....... CENSUS TRACT.uJ.................. <br /> Owner's Name,.rP ......�!.(. sKti:...%..� ..:........ ................. n3 rJ ...Phone...........;.,..,..................... <br /> Address..........:.:..`Jo_.a. ...... City. . .... ............ ....................Zip...:.. ..;....... ........... <br /> Contractor's Name........... ..��' <br /> ....:............:...:..... / <br /> ... .... .... . ... .. C?,v.-s:;%c�..............................license #.�lp..r�-C�--.�,�......Phone...YCcr�.:r�6�fi..... <br /> Installation will serve: Residence Apartment House [I Commercial ❑ Trailer Court E3Motel ❑ Other).,.:........................................ <br /> Number of living units:...../.......Number of bedrooms....c;;?..Garbage Grinder..........,.Lot Size..A���... :.................. .. <br /> Water Supply: Public System and name....................... . ..........................................................................t Private Character of soil to a depth of 3 feet: Sand El E] . Clay ❑ Peat❑ Sandy Loam [3Clay Loam ❑ r to <br /> Hardpan' Adobe❑ Fill Material.. ... ..t.lf yes, type................................ <br /> '(Plot plan, showing size of lot, location of system in relation to wells, buildings,etc.must be placed on reverse side,) O <br /> PACKAGE TREATMENT [ SEPTIC TANK ( eepage pit ,) <br /> ) <br /> NEW INSTALLATION: (No septic tank or seepage 'permitted if public sewer Is available within 200 feetSize ......_..................................................Liquid Depth.....'............ ...... i <br /> ' Capacity.....................Type........................Material.........................:No, Compartments......:.:.....................,.. <br /> Distance to nearest: Well.....................:........... .........Foundation.......... . .........,..'Prop. Line.........,................. <br /> LEACHING LINE I 1 No. of,Lines . ..............__.......Length of each line .............................Tota l Length ....................................... <br /> tYP Distant...to nearest:Filter Material....................Depth Filter Material........................... .........................•......... <br /> Well ...........I......Foundation............................Property Line..............:.........,.......... i <br /> SEEPAGE PIT [ 1 Depth................Diameter...-................Number.........,..".................... Rock Filled YeS❑ No❑ <br /> ' Water Table Depth.................................................:.:...:Rock Size...........,.,......I.,........................ <br /> . <br /> Distance to nearest: Well...........................................Foundation..........................Prop. Line............................- <br /> ' REPAIR/ADDITION (Prev. Sanitation Permit#_. ....... .... s,..,..;.,........ ...............Date................................... / ..� <br /> Septic Tank (Specify Requirements)..-.- --- - - •- .--. - " ':�". <br /> Disposal Field (Specify Requirements)... .. ... ... . � <br /> . ..,.Q �J' ^lru <br /> ' ........ 'r ,tf ..- ...:. .......R'...-'........�rR................._,................................................... <br /> .. <br /> �� 0 `. .. . ... .r.... ...... <br /> ")Draw existing and required addition-an reverse side) <br /> ' 1 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: i <br /> ' "I 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 /> to become subje(r _W rrkina Com en-sa-It Iaws of California.' p l <br /> Signed.................., . 'e.Q..La-..':. 61i - wL.-..-.... .;...,,........ ..........Owner �. <br /> By.........:...................................._a. ... Title...... .................,............................... � <br /> (if other than owner) <br /> 'RoaEPART ENT USE ONLY <br /> ' APPLICATION ACCEPTED BY...... .... ....4. -.................. .PATE .... .. .. .� <br /> _ . ........... <br /> DIVISIONOF LAND NUMBER............... :.................................................. ........:..............................DATE......... ........_..... ..... ................ <br /> ADOTIONAL COMMENTS............................................................_................................................................................. ......:....... ........ <br /> ............................................:.................. ........... .. .............................. .. .....:.......-....................................................... ....,...I... <br /> ........ ....:.................................. ....... .. ... ........;......... � 6 <br /> . .. . . . . ......... .'.^.. .. <br /> Date,.. 7 rl.�l...... ., e_ .......... <br /> ' Final inspection by:......... ... ... ..... <br /> EH 13 24 SAN JOAQUIN L HEALTH DISTRICT rss 2: n REV.7/76 3M <br />