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- FOR OFFICE USE: <br /> FCR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> � Permit No.�.7 <br /> ----------------- (Complete in Triplicate) <br /> �" .. c1'-t� Date Issued. :- <br /> This Permit Expires'l*Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District <br /> anfor a d existing Rulrmit to tes and Regulations.. Work herein described. <br /> This application is made.in compliance with County Ordinance _ r T A <br /> JOB ADDRESS/LOCA I N.. <br /> =y3�'__. _�_ CENSUS TRACT------------ <br /> i --------------------- -- Phone <br /> Owner's Name-..-- <br /> .....r _ ... ---------__- <br /> V -v_ _ .. ... ... <br /> Address_.. �. hon <br /> i i� <br /> ty, .•, . <br /> l,.- P S " <br /> _ - � - ----- �------=- --=License #..27. <br /> Contractor's Name i f, <br /> ;. <br /> Residence <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Installation will serve: Othe _ <br /> Number of living u its:_.'. _._:_-_--Number of bedrooms_.° Garbage.Ccindea Lot,Size <br /> f r ' Private <br /> -- - -- <br /> s - <br /> _ : <br /> Water Supply: PublicSystem and name__... ------ ---i-- -- _ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ .Ciay ❑ : peat [ Sand Loam ❑ Clay Loam ❑�. J� <br /> Y <br /> Hardpan Adobe ❑ Fill Material-_ __.. -If yes, pe-- <br /> ty - - <br /> _{ <br /> s (Piot plan,s owing size of lot, lova tsystem in relation to-wells, buildiings,Letc. must be placed on r—evecse side:l' <br /> NEW INSTALLATION':' (No septic tank :or seepage-pit permitted if prublic segwer is available wlthin'20 feet,) JJ <br /> "/ Size_- 1 ......- '�- ----------- <br /> JK <br /> LiquidrDeptli <br />[ PACKAGE TREATMENT.:[ J . SEPTIC TA <br /> -� dtat8�i�t" % Nn-Compartments. -_ -------- <br /> __. . Capacity - TypeP� ,,y„� <br /> w <br /> -r --------- <br /> Length. <br /> f. Foundations-f=. -- Prop. Line___5 I <br /> :Distdnce to-nearest: Well:.._ .., f <br /> ~LEACHING LINE'` [ No.of Lines: --- Length of each li}s� CS- =' Y ; g� l `i <br /> + .Total Len th <br /> --------------- <br /> I�_----- pe Filter Material r. a / r <br /> D' Box_ (C�Depth.F,ilterMaterial _lAss _ <br /> �., �.., �� Q__ .Pro erty Line _ -------------------- <br /> once <br /> - <br /> l.. .:____-Foundation- i p Y <br /> Dist ance•to nearest: Well.-__ {i -- ;. Fill <br /> r •..a �7= - Number' R e� Yes No <br /> T t Depth Diameter---- <br /> SEEPAGE ,frl fir..�k <br /> SEEPAGE Pk _ ock Size:__ 1` <br /> Water Table Depth ---- -- - s . �.fs�-- <br /> Distance!to nearest:,.Well.___..___--1 .-----'-- Foundation_-,..I I `---------.Prop. Lirie.__. <br /> t Y -.- <br /> • • F ...;..�.� ..-.. <br /> ' � ------------� ---- - ------------ <br /> /ADDITION =----Date --- --- ="------- -�-_--- .------•- -1 # , <br /> REPAIR (Prev,(PreySanitation Permit#__- <br /> t _= --- ---- - - - -- -- - <br /> F _ �.�. - ----------------- ; <br /> _ 5.. <br /> Septic Tank (Specify Requlrements)_ ">---------------------- ; � - ----- <br /> ----- - ----- --------- -- <br /> Disposal Field(Specify Requirements <br /> - <br /> + '. <br /> -----------------------::----------=.------------- :::---'- <br /> :---- <br /> ---------- --------------------------------- ---- --- ------------------------- <br /> ----------- , <br /> prepared � r <br /> ----- <br /> (Draw existing and required addifiion.on reverse si e <br /> I hereby certify that.I have ;this application and that the work will be done in accardance=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 followings <br /> "I certify that in the perforri7ance of the"work for which this permit is issued, f shall not employ any person in such manner as <br /> l to become u iec .to Workman's Compensation laws of California." - <br /> F �-- y <br /> E Signed = r <br /> ------------------ <br /> --------Owner. <br /> -/-- --------- <br /> ---- - -- ----------------------- -------------- <br /> B _ v ;. <br /> f y - ---- ,,�.. , rT tie ;{ <br /> �` (If other than owner) ' r I f r ; ? <br /> s _ , 'FOR DEPARTMENT USE ONLY ` <br /> - - ---------- -- <br /> ------- <br /> E <br /> - <br /> --------- ---- - <br /> -------DATE _ �5. 7'7 <br /> a <br /> APPLICATION ACCEPTED SY�'.._____�--='--- ---------- ----------- <br /> ---- <br /> --------- - <br /> OF LAND NUMBER ------------------- ------ <br /> ---------------------------------------------- <br /> DIVISION _: .DAT <br /> ADDITIONAL COMMENTS--------------' ..._ -------- ------------•---------- <br /> ------------ -- ------------------------ - <br /> --�---------------------------- <br /> ----------------- --- -- -- <br /> ------------- ------ --------------. - <br /> ------ - -- <br /> - --- ---- ate- - --=--- ------� >---------------------- <br /> Final Inspection by:- ---- - l F&5 21677 RE 176 3M <br /> Ex 3PL� , SAN JOAQUIN LOCAL HEALTH DISTRICT f <br />