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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------•---------------- _______ _ -y <br /> J. (Complete in Triplicate) Permit No.,_>Iy-_�1*3 <br /> i Date Issued,lD__,3P: 8 <br /> -•----- --- -------------------------------- ----------- This Perm.it 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 /> 'JOB ADDRESS/LOCATION. 'i e -t:-_ ---�__ ; _ _ <br /> Owner's Name______ <br /> g " - ---- ------ --- -- <br /> ' Phone <br /> c - --- . . . <br /> -___ <br /> ' " - - '�- <br /> °City zip----------------------- <br /> Address � <br /> Cont1 .ractor's Nameett.�,J J t_,�_ � ___ ice <br /> Installation will serve: Residence AApartment House.D Commercial ❑ Trailer Court' ❑ <br /> p t <br /> Mote! Other-------=---------- ----------------------- <br /> Number <br /> -------------------Number of living units:.----- ------Number of b drooms:'-----Garbage Gr.inder_`- '-Lot Size.-.=-__ -__ �-['/ t.c --- ----------.� .- <br /> t <br /> Water Supply: Public System and name - ------- - ------------------------------------- _Private <br /> ----------------- <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay p Peat ❑ Sandy Loam ❑ Clay Loam ❑ '• <br /> ' Hardpan r'-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: 7jNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT <br /> [ ) . SEPTIC TANK _ Size {� r Q ' '- <br /> ___------ Liquid Depth-<_- -.----------- <br /> Capacity/,)�4 -� -_�Type�AZ Material--_ - -.--- _-No. Compartments.-----.2;�------------------- <br /> Foundation Prop. Line `fir W <br /> 1 :_ Distance to nearest: Well_.., - Z. <br /> Len f <br /> LEACHING LINE No. of Lines--.--- gg- <br /> ;. _. .�C--.- -- �-_ -Length of each line.----- --Q,-- -- ----.Total Length.-: --------------'-------- _ ---- <br /> 1N+. D' Box----4_;_-Type F(Iter Material /& -----.Depth Filter Material--- l __�------------------------------------------------ . <br /> : Distanca;to nearest:Well--`,S- V- Foundation--_ ______-------.- Property Line____4-------------------------- <br /> !'SEEPAGE PIT ' De th __'- Diameter_ ? .__. --- _ <br /> Number_ .__---- <br /> p, - _ - ------------------ Rock Filled Yes ' No E]h <br /> Water Table Depth., --- <br /> --.Rock Size__-__ <br /> f Distance.to nearest: Well._-. ___ ------------------------------_Foundation-------lQ----------:- Prop. Line__Is _--__------_- .. <br /> - - - r <br /> �ii PAIR/ADDITION~~(Prey. Sanitation Per it# � -at- - -----'-----_ ----------------------------------------- <br /> e <br /> �----'-- -----�-----)------------------ • il, <br /> Septic Tank (Specify-Requirements)____________ _ __ <br /> �blsposal Field (Specify.Requirements)=--- ----- -- --------------___------------- --_ <br /> ---------­-- = <br /> } F ._ --------- <br /> __ <br /> -- (Draw existing ancl4e wired add it••ion-on-rev-------------------------- <br /> rse side) , -________ w - <br /> I hereby certify that I have prepared tthis. application and*fhat.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 t e following: .T <br /> "!,-certify that in the performance..of thetwork for which this, <br /> is issued,'I shall not employ any person in such manner as <br /> to become subject to Workman;' Compensation}law's of California.'- _ <br /> Si ned i # `'` I - :. Gl 1, Eu <br /> ST <br /> G4':R SERVICE <br /> ----- - --- ---_. <br /> 9 t- __ Owners <br /> :,. -... S S odd,,. , G�Sif 9S2Oa <br /> gY----- - - f• - -- - - - ,- <br /> Of oth"er an owner) <br /> 4 <br /> FOR+PIPARTMENT USE`ONLY" <br /> 1i <br /> APPLICATION ACCEPTEp_ 3Y._ s - Y L * - --------,_-_DATEA _ ------­-------- <br /> DIVISION-OF-LAND-NUMBER <br /> -_-_ -DIVISION_OFLAND_NUMBER ---- ------- - ---------- -- --------------- ------------------------ <br /> ADDIT OVAL COMMENTSs i <br /> l€ = <br /> --- <br /> ---------------------- ------------------------ -------------------- - ---------------------------------------------------------------------- ------------------ - <br /> -------- --- ------ --- ---- <br /> - - ---- --------------------- <br /> �._. <br /> Finalrinspection;by. � - <br /> = 'Date ----- <br /> -'`_ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .�EH 13 24s - '^ F&S 21677 REV. 7/76 3m: <br />