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FOR OFFICE USE: FOR OFFICE USE: <br /> I APPLICATION TION FOR SANITATION PERMIT <br /> 1c,, Permit No. .._ <br /> (Complete in Triplicate)= - <br /> J <br /> Date Issued.//c...2. _,28_ <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 /> _ �. r... <br /> J08 ADDRESS/LOCATION,._._: r <br /> ��1`a......... ...:: ✓�� ......................_ .... � :. NSUS TRACT.. -- <br /> Owner's Name.... 11� . <br /> JOB <br /> _.... ........... ....... ... � Ph ne_���•- .I�y�... <br /> Address....�.S�l r?......_ GC.! .. r :....'.....'.... city <br /> ..... <br /> ,• y-.-- .•"-.. ........... ............:............:.Li ense #_. �r_ / - Phone_ 6.?'•2�/ ... <br /> Contractor's Name....... .. _._ <br /> Installation'will serve: Residence [R' Apartment House❑ Commercial Q Trailer. Court.❑t <br /> j. Motel [I `Other........ ............ _......................... <br /> N{ber of living un is!_ `_..Number of bedrooms... .__.Garbage Grinder_......_....Lot.Size. -."_.-_ ...__. ............. <br /> Water Supply: PubliAc System and name..... ............ -.:..:.....: .: :\ ."r� Private, <br /> ... <br /> Character of soil to b depth of 3 feet: Sand ❑ Silt L] Clay❑ Peat❑ Sand "C ay Loam <br /> ' Hardpan I-] ;w Adobe"E] -Fill Material.....:......If yes,type ..,_.._____-- �lQ`''c "' � <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,'etc. must be p ace <br /> NEW INSTALLATION: {No septic tank''oC'seepcige ;pit permitted 'if public sewer'is available withiW.k0 feet,) <br /> PACKAGE TREATMENT [ 'J SEPTIC TANK Size.-.. ..'._...__ ___ <br /> S - `Li uid Depth......... ... ........ <br /> Capacity-Ivlp- •-•-- TYPe ,�f-F*a!r4-::.••Material_ Compartme,ts..............r?.................. <br /> .._ Distance to nearest..Welt.'- ..............................•Foundation".14).........-_.....Prop._Line-.5.. . . . <br /> LEACHING LINE I No. of Lines........ -.__-_,length of,eacch/line....��_��Q,.�?Q__._.,Total nLenq�tF�...1aZ/.Q.__._._..�...-.-:__.. � l <br /> D' Box... Type Filte�7lat al �?.!�j'D`epth Filter Mater�al.__�:�L,�--r-;�`.-.*-'- � i <br /> ilte..; . <br /> Distance to.nearest: Well. .....................Foundation._.. .................Prope#ty�l.ine..:'�_.--r-----—---. _ <br /> SEEPAGE PIT [ ] Depth.... ....D.iameter•...'L. ......" Number...;J--_I_----_• __ _ .-- '_ -Rock Filled . Yes ❑ No❑ <br /> Water Table Depth...:.. A...........:...............t...........Rock S_Size.......... ----:..........---••---- <br /> } Distanee to`nearest:'Well::`_": ' :':::j: :..:.._.__.__. .`.-._-.Foundation................:....�t.Prop. line........................._ A <br /> REPAIR/ADDITION (Prev;Sanitation-Permit....... ...... ......1..- ------------------ -------Dat!---- .......... .:--.----.I <br /> Septic Tank (Specify Requirements).............i::.:.::.,. .:.: _ ... -t ._:..:..:...::••..................... ...... ...::.,,:.:.::...-f__.._ t.-. <br /> i <br /> Disposal Field (Specify Requirements} <br /> . � <br /> J ,. <br /> . . ............................... ------------ <br /> ........................ ............. <br /> K <br /> ------------ <br /> ' ............... <br /> / . . -----._ ... , <br /> ................ .. ..._ ; -f r'...- _ ...... ...... ' <br /> .. ' ` <br /> (Draw existingand required addition on revers <br /> e side] A O <br /> I 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- Sari Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: i <br /> of as— <br /> "I certify that in the performance of the work'for which this per?riif I"Issued, I.shbil•not employ any person in such m nn <br /> to becom - /ybiieect to Wo man's Compensation;laws .of California." .. :.. . <br /> Signed_ <br /> ...._... -..... .. ................. <br /> _ <br /> �/ ,if <br /> . <br /> Owner , <br /> ;Title <br /> { f other tFian owner) <br /> FOR'DEPARTMENT USE ONLY` <br /> APPLICATION ACCEPTED $Y..--__:: ..... <br /> -..Q.Z- : .vlil.... DATE..._//. _Z?'? <br /> : DATE............. ..... ... - ......:-�.T... <br /> DIVISION OF LAND NUMBER....... -. ; ........ -::..-: :..... -: . -: .... ....:..: . <br /> —� ADDITIONAL COMMENTS_._..... . ' - -..... � / L. <br /> J ) .. <br /> :.. hS.o __C 4 _:::`moo.:...-!_n....._soc ._ . -?-..._.�11 -_: .. . �SGS/1Tz �ir :...:Ir 1 <br /> t _ - _ <br /> ............................................................'_. ... - T .. <br /> .. _ ................ <br /> ..:_ <br /> ii ..... ....................................... .......................... ......... ...................................... ......... . ..._._. <br /> _. .-.-Date..-.1Z <br /> ` Final Inspection-b -� - = -rla-�-._.'. -- �...................._•��- ...............y.-'------�"•`•--'-'------- F85 41677 REV. 6 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT - - <br />