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FOR OFFICE USE: V FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - (Complete in Triplicate) Permit No..7.q.......... .. <br /> ------------- - ------•-_ ........ ------- <br /> Date Issued.b.*-_f..... <br /> ...........•.......................................•..... This Permit Expires 1 Year from Dote 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-A,,,r /1114 jv v✓yep- �°49A joA vier sivc, GLv6 CENSUS TRACT....... <br /> - -------------------------------------------- <br /> Owner's Name......... � /� . --�7 c-C-"-- �h ------Phone---- ...................... . <br /> Address..--------- O.Ooo . _l�iySSON - Cit Ti-is1c Z, <br /> - Y .+ ---- ----- P-- - -------- <br /> Contractor's Name s o4.v,r�040V . f 'sow_---------------------- ------..License #- f6��S86 Phone S•i3 V-Z/ - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other.....--- --- - -----------_---_--- <br /> Number <br /> ----------- --- _- <br /> Number of living units:.----/.---------Number of bedrooms... Garbage Grinder.-----...._Lot Size.- ........'d..., loam <br /> Water Supply: Public System and name.-_.------+�.!Q-,c............ •....................___--.------ -----Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam X <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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ J SEPTIC TANK [ J Size ..__ ----------------------------..-Liquid Depth..-::...................� <br /> Capacity_/AQp...__Typeb�.C! 7__Material--.-- ­­-No. Compartments......9_--_----_-.-------- <br /> Distance to nearest: Well ...... . ...... __ ..- - ------Foundation... 0e <br /> ._Prop. Line_-O"111..._.. <br /> -- ------- <br /> LEACHING LINE [ J No. of Lines_. ... .....................Length of each line.............................. Total Length -- ----------- <br /> lL Tey Bed 'D' Box. ./ __-Type 9Aafierial _ •Z��e ........... ----------- <br /> Distance <br /> - -- --. . <br />---`-- Distance to netirest: WLII------------ ----- - .__...Foundation....X- ------------------Property Line...-`71 --._..- -...----- <br /> SEEPAGE PIT [ J Depth.. ------ .---:Diameter....................Number..............------------------ Rock Filled 'Yes ❑ No <br /> Water Table Depth-----r ------------------ ------------------_---.Rock Size---- -------------- ---------..-.-..----------- <br /> Distance to nearest: Well.--_-------_....................---------Foundation................ .........Prop. Line..-._...-.._....._... . <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.-..:._.-----_- ----------------- --_..-_---_-Date......:--------------- -_ ..-_- -----.------) <br /> Septic Tank (Specify Requirements)------ - ---------- - ----`� <br /> Disposal Field (Specify Requirements)".-..__... ------------------------ ------ -• <br /> ---------------------------- <br /> (brow 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 San 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 /> �S�ov <br /> Signed. .7-4& Owner <br /> By........ ----- --- ------------------------------ ........................ Title------ ---- ------------ ------...---- ------ <br /> other tha r) <br /> OR EP TME -US O)ILY <br /> -- --- <br /> APPLICATION ACCEPTED BY :'- DATE " `` .- - <br /> DIVISION OF LAND NUMBER._.........--- _-- - <br /> --............................................ .................................--- DATE------------------- --...__ ----- ----- -- - <br /> ADDITIONAL COMMENTS_--------- ---- -- - - .............. - <br /> --------------- ------- ---- ------ - ............ .... .................... ----- .. <br /> -------------------------------------------- ........ -------------------.......-- ----- .. <br /> FinalInspection by-------------_----------- - ---------------------------------------------------------Date--------- ----- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />