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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ICompiele in Triplicate; <br /> Date Issued <br /> .. .. . . ._ _. .. .. .. This Permit Expires I 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 <br /> described.This application is made in compliance with County G-dinance No. 549 and exiting Rules and Regulations: <br /> JOB ADDRESS/LOCATION ' .....;'- i'C.'L = •�i 4s: '�C SUS TRACT <br /> .......................... <br /> Owner's Name ._... //;q:.:i. Si_... ..... .. <br /> ,� / C �.%r/G:..........._._........ ....... ..... ...... .....................Phone ....... <br /> Address .L).—i'.c!...../_L._.._« ..16 -----------city ................ <br /> Contractor's Nome L r "- - <br /> f-/.-.:../......��li/6:........C.eie..�.i/..................License # .Q_J..�..:..�GPhone� �s................. <br /> Installation will serve: Residence Apartment House❑ Commercial []Trailer Court 0 <br /> Morel[t Other ..... �'/k.4'..../. ...__l.111h•?.tom Q`Ca ['er <br /> s <br /> Number of living units: . .. Number of bedrooms ............Garbage Grinder . . .... . Lot Size ......I_�..-..-..-Ar.--..-.... <br /> Water Supply: Public System and name ......................................_............... ._. ............................................Private.PQ <br /> Character of soil to o depth of 3 feet: Sand❑ Silt " Clay ❑ Peat 0 Sandy Loam C] Clay Loarrt�—�_\ <br /> Hardpan❑ Adobe PK Fill Muterial .... . ..... If yes,type......_............._..... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 100 feet,) \ <br /> PACKAGE TREATMENT j ) SEPTIC TANK I ) Size.. . .... moLiquid Depth h ...._5.:................ <br /> Capacity Type r A--lest.('Materiol. No. Compartments ....d............... <br /> Distance to nearest: Well ........................Foundation J %oP Lint..... .p.../.. <br /> .....�5. <br /> LEACHING LINE [ ) No. of Lines .. .__ . Length of each line _.: v.._.. ... _. Total Length <br /> 'D' Box ';.: , Typo Filter!Material ,17. rZ c..ff',4pth Filter Material _......I9.�. ...............� .......... <br /> . <br /> Dc .0 <br /> tonce to nearest: Well Foundation E.V•✓.../R._. Property Linc .../.?. .r.............. <br /> SEEPAGE PIT : I Depth a j. Diameter :i.._....... Numbe _._ .. Rock Filled Yes Q No Q <br /> a'Jcter Table Cepffi '�.. <br /> .......................Rock Size . r'- <br /> Distance to nearest Wel! . .{*rr. I.j1-.V!_.. ..Foundation .C.irSs...w/Prop. Line ...t.'.:...-......_. <br /> REPAIR/ADD MON;Prev. Snnitaton Permi-41 ... . Date .. ..____... ...... <br /> __..l <br /> Sept.: Tvnk. :Spec=y Recuiremewst - .. . . ...._.. ... ..... . ..... .._.._ _... __. ...._....... <br /> iJsposc. -m!d /Sac:::y Raa_:aT.>ntsi <br /> 10-ow cr;sang and roquirco addition on reverse side! <br /> ! hereby <ortiiy rhe. 1 hove prepare-, this nppliealion and `hot the work will be done ir. accordance with Sae Joaquin <br /> Coun•y Cr•9incmc_s. Sac L^ws, end Ru!es and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents si3noNre certifies the foCowing: <br /> "I cork:`, t.`.ct tho xrfo'marce of the nark for which this permii is issued, t shot: not .mploy any person in such manner <br /> as to become sec'ev' to Workme>:'s Co-izrnsolio.n laws of Colifomio." <br /> i / <br /> c,=nrr'. s ✓'L / /�.�sd(F- (t.vl %. <br /> F DEPAPTMENT USE ONLY <br /> c i.'r / fs DATE <br /> DATE <br />