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FOR OFFICE USE: - FOR OFFICE USE: _ <br /> APPLICATION FOR SANITATION PERMIT <br /> --..,....._..........._.............................. Permit No....UU----...- <br /> (Complete in Triplicate) --'- <br /> . - . / <br /> Date Issued..-- <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................LI�Ji. _,._...f....CENSUS TRACT...- <br /> Owner's Name........ .... . .,.,-,.el. .,.::..........:......... ........... Phone.........-C..`... ....t. <br /> ....... .... ..................... --.-.... <br /> Address.....y...._ t��p .. .....:............................................................ h??J .:-... ........:....Zip�Sq,.-... ......�.+-. <br /> me-...........�.�l.-.. fJ-..rr-.4..�`... ....__--- .�-.License #.4ss,�r.-'ttir.. .'.. .ate..- Phone:c�'c�/..��m..�..f�. <br /> Installation!will serve: - i Residence{Y A artment Houses' Commercial ❑ Trailer Cou4 lC t <br /> Il p I <br /> }: _r . . Motel ❑ ! Orhec:.-.. ^:-.:..._.�.............. ....._ V,6 ,/g C t <br /> Contractor'; Na <br /> - <br /> Number of living units:..': Number of bedrooms g <br /> ..-.:...- . n.J�...._Garba a inder.....-......Lot Size......:..........._. ....-..-..........`--- 1 <br /> Water Supply: Public Sy'em and name.:.................�....�.. ........ <br /> ..................... <br /> . ......--... ..,. ._...;...... <br /> Character of soil to o depth ofi3 feet: Sand ❑ g1XD Cloy ❑ Peat D? Sandy Loam❑ 'Clay Loam ❑ <br /> i } tlardp'ah ❑ 'Adobe fl Fiill Material............ ye's type---............................ <br /> 1 aC'0 : <br /> (Plot plan, d"howing size of lot, location of system in (@lotion to wells, buildings,'etc. must be placed on reverse Rick) s <br /> NEW INSTALLATION: '(No.septic fariki or seepagedp'it"perrimitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TAN1 I ] I Size....'............................. ..................:.:-Liquid'Depth I_..-.._.._..-..--....,.--t� <br /> Co achy _-,.: .aType:::+'-...:-_:'f.. .Materml .No Compartments - <br /> _ Di bnce.ta eorest�`V+L I„ . .�r'a.1-� -....- FoundahogN .az i1 -.;..Prop Line........ ........... i <br /> LEACHING LINE' (r] - N ofJ,yng _ t`...ILen*X of each line !Xotc l Length 1_.-L! t.............. <br /> D Box......... Type Filter tAotgn(6L;$teePr <br /> � Depth r Material.. 9 <br /> ' <br /> Distance to nearest: Foun2lation. .. -� - --. opero Lme <br /> SEEPAGE PIT I ] Depth....;... Diameter l�;_:......:�Nernber,,,---- .....�5-��_ -�^^— - nock Filled: Yes❑ No p <br /> . _ l <br /> Distarice'to nearest:Well.-' � ...-�- ...--:----.............Rock Size:....-----•-..:..------ -------------------- <br /> Water Table:DeptFi-..:-..-..: <br /> .el_# .-..---:.':.::..:::..........:Foundation..,..-....._....:r-._--.Prop. Line...--.. <br /> REPAIR/ADbIT1ON {Prev:Soriitation-Permit#.::..--....fr-;::---_.::.::.:....-...�:..�.-{...Daher: ._. --} , <br /> Septic Tank!(Specify.Requirementsh..,...._./,d:4, ......--✓,'!-*1.:5.. - <br /> Disposal Field (Specify Requirements]'-,.....-. .:�.1 - --- ...._.... �C -...2.2.It1C.r.�._........,....../ - - --.:..j. <br /> ---------------- �---.... --<------..-.......-...:t... --. F�z�..�.�..-:G-rte./.:....... . -._�:_:.. ... <br /> ................ ----- -...-..-------7­­­.--....-.-....----.........------------ ....... ........... <br /> I. ..., i..._, ). y, <br /> �� a!{Draw;existing and required addition on reverse side) � ' <br /> I hereby codify that hove•prepa4ed this appye ition and that the work will',be-done,inlcc`aordance with San Joaquin County_. <br /> Ordimmces,. State Lows, and'Rules andAegu=tions of the San Joaquin Local Health Ds1 t. Home owner r licensed agents <br /> signature torr fifies the followings �,t+a . <br /> "1 iertify that in the performance of the work for which this permit is issue\d,`i shd8 nofemploy any,person in such manner as <br /> to become`subject to W 09, 's Com nsation laws of,California." <br /> .. �r <br /> Signed.... . .� _ . Cnvne }��\\J <br /> By.B ....:......:.....:.. ........ ..... r` <br /> ........... <br /> ' { - {If other thani wrier) '� ?� \'�l"\''i3m'Tt'r! . <br /> v <br /> DEPARTMENT USE ONLY, I t l I <br /> APPLICATICNJ ACCEPTED BY.:., ..- -.. . . ` .. r..:.:._:::.-•..:-......DATE.i ;:..6_'. 7 . .-........---- <br /> DIVISION OF LAND NUMBER:----..a..................-;......:....- .. --.:...,..........-....... .:...DATE,`_.._.......:..- ....--- ..--•----• <br /> ADDITIONAL COMMENTS.....:........................................ ... <br /> 4 <br /> ................................................... �........ _........._._:.__.:......:................ ------' ---"--'--'-_--..._-- ...._..... ..---...... <br /> .-...._..........:.... .... .... :l .- .... -_...._... _ ..........'.--..- ._...-..................• ....... �. ......-.. ... ..............}_.. <br /> - .. ....Date....7. /r-.7 <br /> FinaLlnspection•by:-/'L/c r...-: fZC....::.:. ....... ... .. . ............. ................. -gip.: 70................ <br /> I <br /> EH i3 U SAN JOAG!UI LOCAL HEALTH DISTRICT F65 21E1] REV.]/]6 3M <br />