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FOR OFFICE USE: � ` r- FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Q <br /> (Complete in Triplicate) Permit No,-.-7 .'s_-_._. <br /> ----------------------------- --------------------- z 7- 7� ` <br /> Date_Issued-_.___ ------ -----This-Permit-Expires 1 Year,Frorfi'D-ate Issued— <br /> Application is hereby made to the San Joaquin LiocWHealth District for a permit to construct and install the work herein described.8 ' <br /> This application is made in compliance with County lbrdinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI � f✓ �•� i ;i <br /> - <br /> b TR -ri <br /> ----------- ----------- <br /> ----------- <br /> -- ----- <br /> Owner s-Narrle-. <br /> . - _: hone If------------- <br /> -- <br /> ----- ---- <br /> Address--- = _ z� �•. I <br /> r - �r� <br /> "" �- _-.. <br /> , • +_-. ,r -- - _ itY+ ----� - - -- ------.-------- Zip--- --- -------- --- <br /> - <br /> Contractor's Name.-- :_ <br /> -- --- - - �--� - - - .License # ?hone <br /> Installation will serve: } Residence Apar m66tt I4ouse.❑= mrnercial ❑ Trailer Court ❑ <br /> i s - `. a p Motel ❑. Other = - --------- <br /> Number of,livini <br /> g unitS ` Nurriber of.bedrooms --- _--Garbage <br /> Grinder_ti`, Lot Size�------- �� - 4------- ----� --- --------- <br /> Water SuPPIY Public S sterni s :- _ -- <br /> Nand name i - j, --------- ----- ------ Private <br /> Character of soil to a depth pf 3 feet: San Silt Cla ; <br /> P ❑ ❑ y ❑ . Peat ❑ iSandy Loam ❑ Clay Loam ❑ <br /> FHa�dppn ❑ Adobe Fill Material-----_---___If yps, .type----..-_-- - <br /> 'c, - 1 , I [ <br /> (Plot plan, showing size_of lot, location of system in relation to:wells, buildings etc, must be placed on reverse side`) y <br /> NEW INSTALLATION: [No septic'tank orseepage pit permitted if public`sewer is availabl "'thir?s200 feet,) = = .,a <br /> PACKAGE TREATMENT [ ] SEPTIC TANK - Liquid Depth. -..___. <br /> E"l Size <br /> t <br /> z Capacity Type Material-'' = o.TCompartments------ ------------------ <br /> I��` Line ------------------- <br /> N� <br /> LEACHING LINE [ ] No3"of"Lmesp_.� Lei"th of'eacFi line- Y 1 <br /> ,.. : Total Length.:---- - --- - <br /> ( YP t tial ------ Depth Filter Material --- <br /> I ` <br /> Distance:to:nearest: Well_=------j - <br /> Box-__-t-^tiT e Filter Mate----------------- Faundat.ion----------------------------.Property Line---------- - <br /> SEEPAGE PITr <br /> [ ] ^,IaepthV'I _____Diame#er ------ ---------Number -- �------- ----___-- � = Rack Filled .[Yes ❑ No ❑ ' <br /> Wa �4be!Dpth- <br /> _e -------------------- ----- --� ---.Rock S'z <br /> Distance to nearest Well?------------------------------ <br /> :_- ---Foundation- --------- --Prop. Line- ------------------------- <br /> REPAIR/ADD,ITION (Prev:-tSarritati&Fi Permit,#-=- '- --° T----•-•----- ------------- <br /> ----- Date---;---.--- ----- ------------j-- :---1 <br /> •� i1 1 --------- i . <br /> --- <br /> Septic Tank` S ecif Re uirements - :..-: ` <br /> P ..}.v a(`p. Y q 1 =- ........ . . _ ---- ----------------- --------------------------------------- --------- - -- <br /> Disposal Field (Specify Requirements) _- ....... 4P------ - r <br /> ` - ----- <br /> ------- - ' `r -------------- <br /> -. ^r" -- ------ <br /> --------------'------:------- - <br /> - - - ----- ---- <br /> I " (Draw ezistrng and required addition on reverse side) <br /> I hereby certify that 1 have prepared this.application acid that'the work will be done in accordance;with San Joaquin County <br /> the San Joaquin Local Health District. Nome owner or licensed agents <br /> k <br /> Ordinances, State Laws) and Rules and R4ulations of <br /> signature certifies the following:,` ' ; 1 <br /> "1 certify that in the performba6W,`6f4fhe work for which this permit is issued, I shall not employ any-person in such manner as <br /> to become subject to Workman's .Ci ompensation: laws of California." 'fit <br /> Signed- t - <br /> .-. Own <br /> BY Title ~ <br /> j o er than owner)'- . <br /> FOR-DEPARTMENT-USE-ONLY s <br /> APPLICATION ACCEPTED BY-_--: - TE — ` <br /> --------- ------=-- ----------------------------- -------------------------DA ----------------------- <br /> DIVISION OF LAND NUMBER .---- <br /> '" � '=-- = - - = - -_ --------DATE-------------------=----------------- ------= <br /> ,.ADDITIONAL COMMENTS------ ---------------- � ,w <br /> --- =--- <br /> ►. <br /> ------------------------ ----------- <br /> 7- <br /> ------------------------- ------------------------- --------------------------- [ <br /> Final In ection b 1� d^-� = ._. - -------Date- <br /> /L,/- -------------------- <br /> PY - / = -- --- ------- ------- - =---- --- '--- <br /> EH 13 24 SAN J QUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M f` <br /> f <br />