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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------- ...... ...... Permit No.,7;r ----------- <br /> (Complete in Triplicate) <br /> ----------------------------------- ......... <br /> Date lssuecl./e-&7,_7e. <br /> ................ ........................ .......... This Permit Expires I 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 Ordinanc:2 No. 549 and existing Rules and Regulations; <br /> JOB ADDRESS/LOCATION.....//ado-----C. . ....I ...... -- ------------ - ---------­--------------------CENSUS TRACT---------------------- -- ------ - <br /> Owner's Name......... .......... --- ----- -- ------- Phone..... ...... <br /> ................................. ... . . <br /> 22 . <br /> ?1�r;? C-1-A <br /> 7ip <br /> �ity <br /> Address_-.- , --------- ---------- <br /> ......Phone-------------------- ----- ------ <br /> Contractor's Name...... ------- <br /> ---------------- - �t-�4.. .............. License <br /> Installation will serve: Residencb � Apartment House D Commercial E] Trailer Court E] <br /> Motel ........... ------------------------- <br /> Number of living units:..:.....'-....Number of bedrooms-...3....Garbage Grinder..... ..-,-Lot Size.__{..__ <br /> --------- ---- ........... -------------------- ---------------- ........... ---- ----------------------- <br /> Water Supply.. Public System and name--.- Private X <br /> Character of soil to a depth of 3 feet: Sand [D Silt [] Clay E Peat'D Sandy Loam El Clay Loam <br /> Hardpan E] Adobe Fill Material. -...If yes, type----7_------ :-... . <br /> (Plot <br /> ype----7 ------------------ <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 within 200 feet,) <br /> PACKAGE TREATMENT 74 SEPTIC TANK Size........ .... f ----ep------------- ---Liquid Depth.------------- —' <br /> T . 11 A_ <br /> Capacity ... Type_.: Compartments ---------- ­I............. <br /> Distance to nearest: Well...-..- ---- -- Foundation...YO."..­4", ...Prop. Line_..1�7,11.... ....... <br /> LEACHING LINE ........ <br /> No. of Lines .................Lengt f h <br /> ........Total Length ... <br /> 'D' Box....Sn�-�.Type Filter Material.. ..... Filter Mater .....1.. -----------I---- <br /> ... ........ ......... <br /> Distance to nearest: Well--------5 D....17... Foundation.... -Property ine._,.5 f <br /> No <br /> Depth___-X�_. 33-------Number, ...... 'Yes <br /> SEEPAGE PIT ...Diameter., ­--------- Rock Filled <br /> Water Table Depth----------------------- = --------I----Rock 'tize-l'. ............ <br /> Distance to nearest: Well- - ---- --.,-:-FoundationProp. Line.'_. 1777 <br /> REPAIR/ADDITION {Prev. Sanitation Permit#....... .... .....::.........Date....-----------......- _­­ ------ <br /> -------------- ..... <br /> Septic Tank (Specify Requirements)---- --------------------- 711...-7-- -1 ------------- - -------- .. ......... <br /> ... .......... -------­............... ....... <br /> Disposal Field {Specify Requirements) ...... ............... ...... ----------------- ......­� ------------------------------- ------- ........ ..­ ----------- ........... <br /> - - . <br /> ............. --------- ---- ------------------------------------------------------­ ......-----------­- --------- <br /> ----- --------- --- -------- ....... <br /> - <br /> ... ...........L------- -------- <br /> -------------------------------------------------- ...... ............ - -- ------------ ----- --------- --------------- -------- ....... .. <br /> (Draw existing and required addition on reverse side.) <br /> I 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 Son Joaquin Local Health District. Home owner or licensed agents <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 <br /> to become subject to Workman's Compensation laws-:of-California." <br /> ----- --------------- ____Ownw <br /> By <br /> ........ Title..:---- ....... ................. ............... <br /> ----------- ---- <br /> If other',than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED. BY- --------- - <br /> ............ ----------------­­_­.. <br /> DATE................. ------- <br /> .............. .................. ........... <br /> DIVISION OF LAND NUMBER_.------- - - -------­--------7---- ------------- <br /> ADDITIONALCOMMENTS. --------- ----------- ------------___---------- ...................I........... ................ ........... <br /> ...... .... <br /> ..................... ..................­... ............... ..................... ......... . ­.......... <br /> ----------- <br /> ...... ------------------- .............. ...... ...................... <br /> - <br /> ----------- ............ <br /> 7--------------- ------ -- <br /> ............ <br /> -/ -��----------- -- ---------- <br /> ----------- ......--- ­ -- -- --- -- ---- _g. . .. ..... <br /> Final,lnspkvor� by....... ------------------------- - ... <br /> F&S 21677 REV. 7176 3M <br /> QUN L DISTRICT <br /> EH 13 �4 SAN JOA� <br />