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FOR OFFICE USE: '—i FOR OFFICE SE: <br /> !CATION FOR SANITATION PERMIT <br /> _ <br /> ................................................ (CewtpMle in Triplicate) <br /> ...... .............................................. Date Issued_.S..,rF-�- <br /> t....................--.---.-....._........... T6k FWiMf�ftpMrs 1 Year From Dote Issued <br /> Application is hereby made to-the San,laaquln Local Health District for a permit to construct oncl install the work here described. <br /> This application is made in compliance with Cou finance No. 549 and existing Rules an ogu tions( <br /> A / r CENSUS TRACT.... ................I....... <br /> ._. <br /> JOB ADDRESS/ TION..,IA_1AA'....�........,_ ..-_-------..... <br /> ✓yy� it <br /> Owner's Name��Q�7... --l..l/L�%�s:Tr!/.lirfr:._:,._�:........ .....- - - --� � Pfione........... .. -------- - ----- <br /> Address...........-'-./..Q:i?Y ci -a!l-`_-.�.<.1.+.' one,Y43co�` �..... <br /> Contractor's Name... ........ ........ ..... . -• <br /> --------------------License iF 3 �L...._Ph - <br /> Installation will serve: Residence;K Apartment House (] Commercial Q Trails Court ❑ <br /> Motel ❑ OtherZ,:',--- ------ ..._.... . ... ..... <br /> ..t t <br /> Number of living units:....Z:__.._-Number of bedrooms----.Garbage Grinder---------_Lot Sim... ................: ...__.._....__.. ......_.. <br /> Water Supply: Public System and name.--...................................... -----------7'Private <br /> Character of soil to a depth of 3 feet: Sand 0 Slit[I . Cloy 0. Peat❑ Sandy Loam j] Cla loam �.. <br /> Hardpan' Adobe o 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.l S <br /> NEW INSTALLATION: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK ( ] _._.liquid Depth................ <br /> ..._-. i <br /> ( ] Size ........... ......................_.....---..._-- <br /> i <br /> GapacitY_ _ .............Type.............. ..... <br /> Material..........................NO. Compartments.... ...:........................ <br /> Distance to nearest. Well---------- .. .. . ....... ... ...... ...Foundation.......... . ........ .'Prop. Line.........,...... <br /> ..._....... <br /> . . <br /> LEACHING LINE 1 ] No. of Lines ..........................Length of each line-------------------_-------Total Length ... ................................ <br /> 'D' Box----..... ..Type Filter Material.......:...........Depth Filter Material.... ............. <br /> Distoncstonearest: Well._.._.-•-.-••-•-•- -_---FounddtIon....._-_----._-..__.-_..PropertyLine.........................:_.....r i <br /> SEEPAGE PIT 1 1 Depth_.. ..........Diameter...,....._....------Number..:._._. ...... _..._..__ Rock Filled Yef❑ No Q <br /> ....-Rock.Sizs_......... ' ..... . _......_............. <br /> Water Table Depth---- -_------ --•... ........ .......... ...... <br /> .Foundation----- .....Prop. Line----_----_--......._----. 1 <br /> Distance to nearest: Well... ...........------ •---- <br /> REPAIR/ADDITION (Prov. Sanitation Permit 4k__. -- Date--__..- .-- -----•) � } <br /> Septic Tank (Specify Requirementsl-------- -- ------....--- -------- ,.a+-t" --_.........._...y..._. <br /> w« <br /> Disposal Field (Specify Requrementsl_. -_•�.Q•% 1,,..- �•{.I". / ------ <br /> r'eatj <br /> RIJ�............-....... <br /> ... ...... . ............ <br /> ')Draw existiired addition-on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son 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 certify that in the performance of the workforwhich this permit is issued, I shall net employ any person in such manner as ) <br /> to become subje W rk'' Co:npensallon laws of California." A <br /> ::. Owner /4WL1 <br /> Signed... _.._ a ..._... .. .. <br /> _6 ..... ....... ............. ""'C"jcc r .. Title..._. . _�...._.__..._.._. ..- ...___.--- .1 <br /> gy. .. <br /> (if other than owner) <br /> EPART ENT USE ONLY III I <br /> APPLICATION ACCEPTED BY._.... --- _...............__------.....----......DATE .._. .. . tfr -- <br /> n VISION OF LAND NUMBER---------- ------ <br /> DATE... --- <br /> i�,.)ITIONAL COMMENTS._........................... ................................................ .....................--............._......................... .._.... ....__ .......... <br /> . ....................:........ .. - _.._........._...... - -----...- <br /> -7 <br /> J <br /> Final•Inspedion by.......... _.............. fat 41077 sev 7r76 2 <br /> M4 is 24 SAN JOAQUIN L HEALTH DISTRICT <br />