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FOR OFFICE USE: FOR OFFICE USE- <br /> APPLICATION <br /> APPLICATION FOR SANITATION PERMIT �, S"l` <br /> - -- ------Y---------------------------------------- ! Permit No.------- <br /> (Comqiete in Triplicate} ti <br /> - ------ ° 3 <br /> ` Date Issued_ `_l `_7.7 <br /> ---------- ---------------------- ----------- ------ This Permit 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 Ordina ce No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.-._=_ �r�----------------------- i 1 = ' t ----.CENSUS TRACT ------------ <br /> Owners Name------------ 1 � I ------------ - ----Phone--- -------- -------- <br /> _ r <br /> Address ? t ------------------------ `City _ Zip <br /> ---------------------------- <br /> Contractor's Name - - License #-_v ,_ 5_.3 9--Ph n _��5.10 --'-- <br /> o e <br /> .serve: - . . artmf <br /> ent Ho <br /> u�se ❑:wT . Commercial <br /> mmP ercial Installation willResidence fA _F. <br /> Trailer Co <br /> urt_, ❑ <br /> MotelF-1Other. <br /> Number of living units:.___ ___ _ Numberof.bedrooms ---`P_Garba aGrrad _Lot_.Si <br /> ----------------- -- <br /> ---�--- <br /> j <br /> ze-- - ----PrivatWater Supply: Public System and name--- -------- <br /> I <br /> Character of soil to a depth of 3 feet: Sand [] �Si t[] Clay ❑ i Peat 0 Sandy Loam 0 "Clay Loam_ ❑ I <br /> i Hardpan ❑ z Adobe, ill Materia 1. 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: ".(No.septic tank 'or seepage pit permitted if public sewer'is available 'With iri 200 feet,) � <br /> f. ].. ,. .K _.[`-.] ------- Liquid Depth-----------------------'--- <br /> PACKAGE TREATMENT SEPTIC TANK` 'i-Size. "" = <br /> '_._Material --.-----x-No Compartments s Capacity ------ .TYPe----- ---_ P ------ <br /> s ------ --- <br /> --- ' ---- ------------- --------------------- Founda#ionxW ='_—' Prop. Line_ <br /> 1. Distance to nearest:Well_- i • -� <br /> LEACHING LINE _ [ 1 No. of Lanes _ _. ,,Length of,each line------------- '-____ Total Length.---------.--:-.-.- -------- <br /> -------------------------- <br /> 'D' <br /> ------- <br /> 'D' Box----- -'----Type FilterMoferial--------------------Depth Filter Material----------------------------------- <br /> Distance <br /> -------- ------------------------ ' <br /> �. Distance to nearest: WO-__ -=--'-------------------Foundation------------------------------Property Line--------=-------------------- ---- <br /> SEEPAGE PIT ( ] Depth:-----------,----Diameter._ __ ''_---.-^---Number---------------- ------- ----- Rock Filled ,Yes F] No <br /> Water Table Depth- '------•----=--------- ---- -------.----Rock Size__Y - <br /> I Distance to nearest: Well.----- <br /> ----- Foundation-_E--------------------.-- Prop. }L <br /> ine----------------------------- <br /> -------------- <br /> REPAIR/ADDITION <br /> -------------------- -- <br /> . <br /> REPAIR/ADDITION (Prev. Sanitation Permit# .__....:........_.---_--- <br /> ; <br /> ------Date ..... ----------------------- <br /> --- <br /> Septic <br /> --5e tic Tank (Specify Requirements)- - - -- ---------- ---------- ------------ <br /> Di <br /> sposal <br /> ---=-=--=Disposal Field(Specify Requirements)-____C " -- -- Q-�`_: _ __�3 ---------------=--if -- ----- ' �' �� <br /> -: <br /> _ --------- ------------------ - <br /> -----------------------------------------------------------------------------"-------------------_-��-----------------'--------------------' ---- - - - <br /> (Dr"awlexi6ing`Eand required addition son reverse side) <br /> I hereby certify that 1 have prepared this applica ionl and that.the,work will- 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 i <br /> signature certifies the following: Q, <br /> I <br /> .'I certify that" in the performance of-the work ear"w'hich'this permit is issued, 1 shall not employ any person in such manner as <br /> to become jest to Wo kman' Comgensatloi laws..of California." ; <br /> gl y - <br /> Signed - . . . . - f=--- ---' Owner. <br /> , <br /> BY-1 <br /> _ •' Title <br /> F --- <br /> (if other than :owner) s s y <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTER BY----:.... ------ -_ <br /> -- --- --- -= --'--- --------------------------------------------------------------DATE t?_-/L�-�'`-I---' _ -- <br /> DIVISION OF LAND NUMBER-- --- ---------------------- -------------_ DATE------------- --------- ' <br /> ADDITIONAL COMMENTS------------- -- - 4` -=' <br /> -------- ----------------- ------------------- ---------------------------- <br /> ---- <br /> ------------------- - --:. . ,._ `4` - -----V-- --r----------------------------------------------- ----- ----- --------- <br /> ------------------------- <br /> ---------------- --------------- ------ - ------------------------------------------------------------------------------------------------------------------------ ------- <br /> Final Inspection b ... ...� Date �`' E11717EV. <br /> ---------- <br /> P y:` - / = <br /> EH 13 24 JOAQUIN LOCAL HEALTH DISTRICT F 7,I <br />