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syr FOR OFFICE USE: FOR OFFICE USE; I+ <br /> .. APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete In Triplicate] . .`/.-..5..�..1 <br /> ..................:.........I........................ <br /> Date Issued..)..n-.A---2" <br /> iR <br /> ..............................."......................... This Permit Expires I Year From Date Issued g <br /> t. <br /> Application is hereby made to.the San Joaquin Loco] Health nistrict for a permit to construct and install the work herein described. <br /> Th's application is made in compliance with County Ordinan,.. Jo. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION....../-. ��' `. ...- CENSUS TRACT............................ ... <br /> Owner's Name.... .r✓G <br /> .... .....Phone.................. ...... ........... <br /> h_ <br /> +- Address.......-.?34, [3—....-.f �.! /L/G/ -.-.._...f.......... ..........-..--..,..Zip............................... <br /> '• ' Contractor's Name....... .......r�O.GCJN /y....... . . .....License #. .................... ... .Phone........ r <br /> installation will serve; Residence❑ Apartment Hous ❑ Commercial Trailer Court ❑ <br /> Motel ❑ Other_ .. ST/Zue� TG�o a� <br /> Number of living units: ..,............Number of bedrooms........... Garbage Grinder............Lot Size.......�6+�. . ��5••••••-- <br /> n, <br /> Water Supply: Public System and name.. .....................".... ............ ............... ....-......................... <br /> :..PrlJate ❑ <br /> Character of soil to a depth of 3 feet: Sand E) Silt Clay E) Peat[) Sandy Loam EDClay Loam I <br /> Hardpan Adebn i_] Fill Material.. ... ....If yes,type.................. . . <br /> ' {Plot plan, showing size of lot, locatrcn"of-sysfem in relation to wells, buildings,etc, must be placed on reverse side.] R <br /> NEW INSTAL;ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) y <br /> ,PACKAGE TREATMENT ( ] SEPTIC TANK, (,-] <br /> Size ..� D.d-. -. '/. ......... Liquid Depth........................:.5 . <br /> Capacity.: `t 9P ! tariol-...-.- .. o. Compartments................ ................ <br /> $ .. <br /> J' Distance to nearest: Well........::-.-:' ......::.Foundation.......... . ......... ...Prop. Line.-... .....:.-.............. <br /> . v ... e- <br /> LEACHING LINE No. of Lines .. .... /• • g <br /> DQ �. ........ .. ..... Length eac ,ne._ ... Total Length .. �.�.......-.....-........-.... <br /> ,� � ,; � -- - :.: <br /> Distance " nearest: Wefi-:.. -/Q..0..............Foundation...../� pth Filter Matenal..:.......1�-..�.-...••••• ..•••• �- <br /> �l D' Box-".-."... ..Type Filter Material". .5.... Y rr�� <br /> �� �� ../ ... .. <br /> Property Line T�v-. .--G....... L <br /> SEEP PlT ] Depth-....-...'`.:::.tDiameter.............. .....Number............................. -.: Rock Filled Yes❑ No o t <br /> . �Vf <br /> Water Table Rath' .Y-..:.....-.✓��.� .................. Foundat oin...rf.�..--.....-.Yro Lin ' ..... .�.-/"�:.4.. µ,`r <br /> nearest. Well.../. .............)^-..... .. .. •..:. p• `4 <br /> 1' 'REPAIRIADDlTION {Prey, an,tat' n Permit#.....i.:......::........ .... .Date...........................-.............. ) <br /> .. .. .... . ....... .. <br /> "Septic Tank (Specify Requirements]..:. . <br /> �.......�.-.-..-.../........................... ............ <br /> I <br /> ........................... <br /> . Disposal .Field (Specify Requirements]........ ...... .1�•-G..........� <br /> . -...�� .................. _:.`. <br /> i .....:..................--............--...--.--.-...-..._..............--.............-......:.._..:.:-....-..-.--.--.- ..........--.-.-..--.-.-........_..-.......... ................................ <br /> ...... <br /> ............... ......................... .-... .- <br /> .................................................. <br /> (Draw existing and required addition on reverse side) <br /> "+1 hereby certify that I have prepared this application and that' 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 "f�_ <br /> slgnatcro certlfies.the following: ; <br /> "1 certify that In the performance of the work for which this permit is Issued,11 ihall not employ any parson in such manner'as <br /> -"fo`"become sub]eit to Workman's Compensation laws of California." z: <br /> y :Signed... ... ...... ............"....:......"................. ...............................--Owner <br /> :............................................... e/r ....-.........--.... ......-.. <br /> Titl <br /> ' (If other than owner) { <br /> ACCEPTED FAR DEPAR ENT 115E ONLY DATE <br /> _ F <br /> APPLICATION ...............`......-. .-......-._..-..:.. <br /> DIVISIONOF LAND NUMBER.........................................I..........-- .......-......................................... DATE......-........................ ................ <br /> t- ;ADDITIONAL COMMENTS.. ......................"............................. .................................................................... . ...................... ...,.. .......... i t" <br /> ..................................................................................................................................:........................... <br /> ............... ...._ - ........................ .................... ............... <br /> ....................... .... ... N7 <br /> F.nal Inspeciion by:...... ... .. .. ........-.:-...........:.....-.Dote... /�-.�1. ....-..v:.............. U <br /> EM :s z+ SAN JOAQUIN LOCAL HEALTH MSI RIOT ras 21677 Rev.7/76 aM 7 <br /> � ;'Y;r�'`'' `+,d��t:e:r.SµY�•Yt..�x, rt.:tt�t»5•R»...-,. ...army"1..•.:t«r::o;•as._.*:r ;ter '%Y,c.t ...---- x -;'�:4.:2�:: ._,,. .M. -�, ," - •a <br />