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WT <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> " APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. _ .._.-_.. ._. <br /> ._......_.. -_ <br /> This Permit Expires 1 Year From Date Issued Date Issued.. <br /> Application is hereby made to the San Joaquin Local Health District for a peFmit to construct and install the work herein described. <br /> This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIONl7.Gv .2�P ,C (%✓(�2/✓ CENSUS TRACT ..... .. <br /> Owner's Name Phone. <br /> Address. <br /> . �'o. 0 City <br /> Contractor's Name- _ _. ( -.aG� -J.- . -'��... , License # ��717.7...Phone..7�v..7 �O <br /> Installation will serve: Residence ❑ Apartment House ❑ commercial Trailer Court ❑ <br /> Motel ❑ Other.:................ • <br /> Number of living units: '.'-..--Number of edrooms -"''Garbage Grinder Lot Size NI <br /> Water Supply: Public System and name.._ --Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ j SEPTIC TANK Size.. ~.�j . ---)(7/0 <br /> _ --------Liquid Depth .;�... <br /> Capacity lJ'.(,�ype _ Material . ........&o. Compartments - <br /> Distance to nearest: WeIISQ............ . . . ........ .....Foundation_-_.� . ....... Prop. Line ....-. <br /> LEACHING LINE [ No. of Lines.- _--/ ---._. ....... Lengthof each lin& _/47e..!.- Total Length ��/�4 � <br /> < . <br /> 'D' Box..../,-. ..Type Filter Material. _ O!C4--- Depth Filter Material-----1..1.-_ <br /> ..._ _ .4 <br /> de <br /> Distance to nearest: Well_. ................ <br /> Foundation...;.. -------------Property Line......... .............. <br /> h <br /> D <br /> SEEPAGE PIT �j'� Depth -�Diameter-- � �' <br /> • .��L..._:.Number...-.. -�-- ------ ---- <br /> Rock Filled Yes No <br /> Water Table Depth -------7C�127------......------------- ------..Rock Size.. .. ... <br /> Distance to nearest: WeIL da-.._-.--_------:.._,--..---_Foundation.. .�(� _- Prop. Line .. <br /> REPAIR/ADDITION (Prev. Sanitation Permit ---._....Date ) <br /> Septic Tank (Specjfy Requirements)- _... --.-_-------------- <br /> Disposal Field (Specify Requirements)---------------- ----- -----, <br /> ................................................ <br /> ---------------­-- •---------------- --- ---- ----------- --- .......... ................................ <br /> .. <br /> — _ (Draw 4xist ng and required addition on reverse side) <br /> hereby cer}ify•that.l have prepared,this,appfication and that the work will be done in accordance with San Joaquin Count <br /> Jrdinances, :State .laws;--and.-Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agent <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 /> o become subject `to Workman's Compensation laws of California." <br /> Signed............... M 1RENCE'S SEPT;(', � SP;VER SERVICE <br /> 3Y ;Title�r........P11;463.409 <br /> r(�!> a.ln,.�1•iG.L7o7U3 -... <br /> ?�,; 'n Oro rlcMn <br /> (If other than owne <br /> 1: <br /> FOR.DEPARTMENT USE ONLY <br /> 1PPLICATION ACCEPTED BY..---------- ---- - .... .. ........DATE ........- 7 . ._... <br /> DIVISION OF LAND NUMBER..-- •----- ...• .. ........ ....DATE.._............-.. . --- -- -- <br /> - -- - <br /> 1 DITIONAL COMMENTS... <br /> ------------- Y <br /> .....�..`... .....--� N' -� ---- <br /> -----••------------------•----- •---------...._.....------...------......•- ---- ---- --- <br /> ----------------------------- �/ •--------- ---- --------------------------------------------------------------------------- ------------------inal Inspection by:. ti -- '------ ----- ----------------••-•-----•--------•-......---------------....------------.......Date .----/!1 5/ � <br /> "i 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F65 21677 REV. 7/76 3M <br />