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tk,4FOR OFFICE USE: FOR OFFICE USE: E <br /> •. "� •- APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. .7. ..-1-/6. <br /> ---------------------------------------------- --------- <br /> �� Date ]ssued.-.J..:f..-4/ <br /> ...............-----------.------:....._.---------.-. This Permit Expires 1 Year From Date-Issued <br /> Application is hereby made to.the Sari_Joaquin_Local Health District for a_permit to construct and.install the work herein described. <br /> This application is made in compliance with County Ordiny�/�c 'No 549 aye existing Rules and Regulations: y <br /> JOB ADDRESS/LOCATION. ---- •...��� .k... -sr- �"� L' � --------------------------CENSUS TRACT............ -•--- ------ <br /> Owner's Name YY-N4ti--------- .5-9q- 338 <br /> Phone .-... <br /> Address---------- / f------ h <br /> Contractor's Name......------ -�J11�.�/. pili' ---.�L. S4Q�--•- --.... - <br /> ....License #.Zd��_-5-8�_.'.....Phone.} 3".yx/ '........ <br /> Installation wilmlzse_rive� Residence (� Apartment House 0 Commercial ❑ Trailer Court ❑ <br /> f Motel ❑ Other.............' ...._-- --- i <br /> Number of living units:.__._/-----....Number of bedrooms........ Garbage Grinder------------Lot Size.....� b!�. ..................:------- <br /> Water Supply: Public System and name.................................. Private ( ] <br /> Character of soil to a depth of 3 feet: Sand Silt 0 bay ❑ Peat ❑ Sandy Loam ❑ Clcpy 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.] �1 I <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I— <br /> PACKAGE TREATMENT [ } SEPTIC TANK [ ] t Size....--............-------­------ Liquid Depth.--------------------.---IV <br /> Capacity .....Type- ye lr Mae, - Gom_,, _No. Compartments........ <br /> ; ..._-. <br /> Distance to nearest: Well-------- .. ........ ..........Foundation. Prop. Line_. ....-------� <br /> LEACHING LINE [ ] No. of Lines .-.--..... ...............Length-of each line.--- 0_`-_.............. Total Length --------------------------- <br /> 'D' Box...../....Type Filter Material_. aG ......Depth Filter Material.....------------------- ------ ------------- ..... <br /> Distance to nearest: Well----4 0-----___.. .,..Foundation__.-7-.0 ........... .Property Line..' ---...._._ (,}� <br /> SEEPAGE PIT [ ] Depth.......... .....Diameter------------------- Number------------_-----------_ -. - w Rock Filled Yes ❑ No E7 ' <br /> WaterTable Depth------._------------_------- -------------------_---.Rock Size------- -:C. - ------------------•------- <br /> Distance to nearest: Well........................ .. .. ......Foundation----------.........1_.'...Prop. Line..----....- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-------------- ---- ------ ___........Date_-------------------.............._.......... <br /> . 1 { <br /> Septic Tank (Specify Requirements)---------- ---------------- - ---- -------....-----------------------------...":. ................. ........... <br /> Disposal Field [Specify Requirements]............... <br /> JI <br /> ------- -•-------- <br /> - <br /> ---------------------------------- -------------- _--------------- ------I------.-.........._--__'.�. ----...ar .--....r...-..-.... _ _ ..... - ------------------------------------ <br /> ES <br /> I F ' _......... <br /> .................... .... ... ........... ...--- _.------- ----------_- ... _...~...._.-.- <br /> (Draw existing and required F 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. Horne owner;or licensed agents 1 <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 i <br /> to become subject to Workman's Compensation laws of California." <br /> L .. <br /> Signed------ "A��T/>Oil/ther <br /> - 5` Ay -----------1Owner E <br /> By............ . ---Title.---- ........ .......... ..... ......... ;-------- <br /> han owner] , <br /> FOR DEPARTMENT USE ONLY p <br /> APPLICATION ACCEPTED BY------- ..�..... . . - ---- - --- ----------- ... --..DATE ..-z.--�-- r ./ ........... <br /> DIVISION OF LAND NUMBER.'_..... - .......................... - ...-----....... -----------..DATE.................. <br /> ADDITIONALCOMMENTS-------------------- -- ---------•----------- -------:--------- ---------------- --------..._.------- <br /> t <br /> ------------------ ----- --......----... . ---- ---- -----.....---- ----.... ---- --------------------- -- - <br /> -- <br /> I <br /> --------- ---------- <br /> Final-lnspd6on b ------------------------ ------------------ Date._Z- -7,�.- ------ ---- ----- <br /> Fas 21677 R �/76 <br /> ert 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT rv,, 3"' <br />