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FOR OFFICE USE: FOR OFFICE USE: <br /> _ /APPLICATION FOR SANITATION PERMIT '"0" <br /> . ................. -. . - - q <br /> (Complete in Triplicate) Permit No..-.7.1:^/". <br /> ------- Date <br /> .. . <br /> Date IssuedS./C'-79 <br /> `...........---.----_.-....._-__.-.._..-.._-....-- This Permit Expires 1 Year From Date Issued <br /> I Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Lfhis application is made in compliance�with County Ordma a No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI N.._C?23 l ./..�_.--,e -. .._.. .. <br /> TRACT__...................... .. <br /> -- ....-.... .. .. <br /> )wner's Name.--- ... Irl--- .. - Phone--. <br /> ` - ....................... .la.-cQ- �. .....__.. <br /> Address__. - .. .. ..._..34.j.... - City. . .. . zip..;------------------------- <br /> Name---------.- - - -P!) ------- --.--------_------........License -- -----Phone....—W_44...--. <br /> j,.0stallation will serve: Residence$Z Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other.....................................------ r <br /> Jumber of living units:..../-...---Number of bedrooms-.O--....Garbage Grinder------------Lot Size---------------. -(� ...:... <br /> .........._..- -- <br /> "Water Supply: Public System and name------.. _..........................._...................................................... <br /> .......... .........................Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan F Adobe ❑ Fill Material.. -._ ....If yes, type.............. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> JEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) J; <br /> "PACKAGE TREATMENT [ j SEPTI <br /> CITAN <br /> K Size ....Y-xSX-. -_-...... Liquid Depth.-.��.....--.--._.--.... <br /> Capacity-/.0200--------Type.OU-1-A4...-.Material.. .--------No. Compartments-------a2...---'}-,y-�--�------.-..... <br /> Distance to nearest: Well......�?�............ ._.--.---------Foundation-. /.Q. .............Prop. Line-.�. ate-...--_.D <br /> r , i <br /> LEACHING LINE No. of Lines....... ..................Length of each line-y0_--Zfl0...VA----Total Length ...................... <br /> nn (Q� <br /> 'D' Box...✓....Type Filter Materiol�C..ifc'.r4 Depth Filter Material.----/1_7r................................................ <br /> Distance to nearest: Well....�R-D!-------------Foundation.-.-G�!Q_..--.------..:..Property Line....� -1.1 w <br /> ..... ............. <br /> r' _ « <br /> SEEPAGE PIT (�eJ Depth.�S__Diameter....3� <br /> .. ...-------- <br /> Number.-..---3.................. a ,RockFilled Yes,$ NoO <br /> ` Water Table Depth.---- f1-�i---- -- - ---...-------.•---.Rock Size....-.0?-)C.3...-.......- ------------ - <br /> Distance to nearest: Well.....1_6.,6 .......................Foundation-..SZ)..............Prop. Line---S.'-. --.-. <br /> tEPAIR/ADDITION (Prev. Sanitation Permit#...................................................Date----.--.--........-----------..---..--.--..--A <br /> "Septic Tank (Specify Requirements)---... ........---------------------------------------......._........................................................ ...-..._------ <br /> Disposal Field (Specify Requirements)-..-------------- -------------------------------- - ... - ------...- -.-.. -------- <br /> r ------- --------------- -- -------...------._..... <br /> ............................------------------------------------------------------------------------------------------------------------------................................_---._-----_-----.--- <br /> (Draw existing and required addition on reverse side) <br /> rl hereby certify that 1 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: <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 sub[e o Workm n'sompensation laws of California." <br /> Signed------ ---- d .(w <br /> -.__... OwnwI <br /> `By---------------------- --- . ...........Title. <br /> - <br /> (If other than owner) _. <br /> j=O DEPARTMENT USE ONLY <br /> yAPPLICATION ACCEPTED BY.. -. . -,C1t. ..-.-. ... ` ------..................................................DATE ....... -- �.. -- - <br /> DIVISIONOF LAND NUMBER.--.._.... ------._------._... -------- ------------------ - ---------------------------------------DATE.-.-------- ....................... - <br /> LADDITIONAL COMMENTS__----------- . .. —... .......... . ............... -- ........ -- ..... ...-- ..... ...... ..---- . .. ._....... <br /> --- ----- __ .. .. ....--. . . ....--.. .. .. — . .. ................................. ------------------------------------ -------- -------- <br /> - ...-_---....... . ... --- "-- ". .-......--.__. .... ................................. 76 3M <br /> -..- - - . . ---.-----"-. <br /> FinalInsPeciion by:.....--�-- --- � -- - -... .....................Date....- -�----- -... ....... ... .......... <br /> `M 13 24 SAN JOAQUIN OCAL HEALTH DISTRICT Frs 2167 i <br />