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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMJT ��,FOR OFFICE USE:N <br /> {Complete inTriplicate) ermit o. <br /> .._. ............----.. <br /> - , ' .. .._. <br /> .................. . .................I­­ :•' - • ., . ,* <br /> `t <br /> �` Date Issued __2 <br /> •---•-•. ----------------------- .`- This Permit Expires 1 Year from Date Issued <br /> 2--q& - tot'.- Z<4= <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal', the work hereir descr'bed. <br /> This cpplicatior is made in compliance with County Ordinarcel`J/D 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC MN!/�.-4v:._.. ► .0 0' aj-�� _.-.....-. . <br /> -. ---...--.CENSUS TRACT <br /> Owner's Name.k r /Jl/_ E ��.` i— Phone )S' J ?-S ZD <br /> .......... . <br /> Address .,/4. ,:5..�jr �(J -�/ ........... City '.... - ' Zip. d`.3 24 <br /> Contractor's Name <br /> ........ _. License Z/4 "� -.-�.:.t� <br /> '.' :. <br /> installation will serve; Residence Apartment (louse ❑ Commercial C Trailer Cour% [ t <br /> _• ''"Motel Others, �• i � •• <br /> - • umber of living units: '. ..._ _ Number•of bedrooms.. �arbage Grinder _Lot Size <br /> I <br /> Water Supply: Public System and nam e.." % ........ ( . _.- .----. ----- Private <br /> Character of soil to a depih of 3 fee•: Sand ❑ Silt F] Cciy : Peat Sandy Loam-[ Clay Loam 9 f <br /> w Hardpan U Adobe C Fi l Material _- If yes, type +~ <br /> (Plot plan, show'ina size of lot, location of system in relat on to wells,buildings, etc. must be placed on reverse side.} t <br /> NEW INSTALLATION: (No, septic ton- or seepage pit permitted if public sewer is available with A 200 feet,j <br /> r ! , <br /> 1. <br /> •'PAC�CAGE TREATMENT [ j SEPTIC TANK �yj Siz '7 :�-Z -cJ ._..liquid Depth �... N <br /> — Capacityl�� -Type. . _M,terial. No. Compartments D .- <br /> I _.'Distance to nearest: Well . .� >_, ,,.:__- .foundation_ /�,' Prop. Line..W <br /> LEACHING L'NE- No. of Lines t>2. Length of each line ��.. . L -S.!_- Tota Leng•h <br /> 1.76................ <br /> ryry <br /> "D' f3ox. .�: .Type Fitter Material i v4R Depth Filter Material....�ls_. .................................. <br /> fto�Barest: Well Foundation-. ! :....Property Line- <br /> 'Distance, <br /> \SEEPAGE P1T / Depth./4_.......[)io dr..?� .. �5er - t <br /> / um. R cK Filled Yes No [, <br /> r 1 Water Table:Depth... !)_�......-_... ... Rock Size .. .. r[/ f f b <br /> ..... .:.. ' ---------- <br /> t Distance to nearest: Well •' Foundation....._. Q.� pro Line.. ~ <br /> REPAIR/ADDITION (Prev. Sanitation Permit.:_..:_,:..:._;... Cate............:;..... : <br /> :.. <br /> Septic Tank ISoecify Requirements)__ . ......:..................• ± .-..... .• :..... ......... - , .1 r <br /> Disposal Field jSpecify Requirements;. -` ... ........ . ..... ............_.... .. _.. .,........._ <br /> r ..............•.......... ............_............. _ .L <br /> --------------- <br /> Ar <br /> . .. ......... AA...- • .. . - .. •............ - <br /> •-- -- ................_. <br /> t !Draw existing anduired addition on reverse side- <br /> 1 hereby certify that-I 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 <br /> "1 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'si;bjec to rhnon's Compensation laws of California." <br /> r <br /> ..Owner <br /> .• /; <br /> By ...... - Title...- ,_..-._ <br /> t (If other tha er " <br /> _i EPAR E USE NLY <br /> APPLICATION ACCEPTED B W <br /> ....DATE... :^.?' .. <br /> DIVISIONOF LAND NUMB♦ ;...-......, .. .... ...... ............ .......... .....................DATE......... .......7----------------- ---- <br /> ADDITIONALCOMMENTS - .................................... .................,............_.................................. <br /> .............. <br /> ............... ...._.............. ...... --••- --......... <br /> .............--•..--•• ,�---- ..... .. ............. .......... ... . _ <br /> r Final Inspection by:.-- ter!' ......... .-.. ---------- ------Date.--..:2~. . ..-�- .'... <br /> . .... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT res x677 REV 7%4f 11M. <br /> is - <br />