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FOR OFFICE USE: <br /> .fOFF.f <br /> * a r <br /> APPLICATION' R-SANITATION PERMIT <br /> 77 <br /> .� P P <br /> Permit No. . <br /> -- 7~'�-s <br /> (Complete in Triplicate) <br /> --------- ------- <br /> ----------- <br /> x z , ',-- Date Issued <br /> -_- h _-..-._-- This Permt Expires 1-Year From DateIseds <br /> Application is reby made t the San Joaquin Local HeaRh District for a permit to construct and install the work herein described. <br /> This applic on is.made in co pliance with County Ordinance No. 549 and existing Rules and Regulations: .. <br /> Y - w-�-�-----------------� �. �-=moo__ � <br /> JOB ADD' <br /> S5/LOCATION. .- / __'_....CENSUS TRACT <br /> TRACT----------- ----------- <br /> Phone_Owner's Nam <br /> Address - Zip <br /> Contractors Name---------- <br /> -----------------_____..__License <br /> s <br /> #__ _ Phone_ _____.___ - <br /> Installation will s side <br /> j serve.. Rence Apartment House ❑ Commercial [] Trailer Court-❑ i <br /> Number of.living.units:- _ .___.--Number of be rooms . -, Ga beige Grinder- 60Lot.Size-. --------------------- s--- <br /> Water Supply: Public System and name -------------:------_ ------ --: ,.-Private <br /> I.. <br /> Characteriof soil to a depth of 3 feet: . Sand ❑ 5ilt� 'Clay ❑ Peat 0 Sandy-Loci r0 Clay Loam 0 YI—� r <br /> �'�f 1! Hardpan❑ Adobe i I Materia .._lf yes, tYPe = `' T <br /> (Plot plan, showi�g size of lot, location of system in relation to'.wells, buildings, etc must be placeed,C evarse side.} 1�7 <br /> --^t - ��;.�.y <br /> NEW INSTALLATION:' (No,septic tank;or seepage pit permitted if publie�sewer,is available within 200 feet„) 3> <br /> R ' <br /> PACKAGE TREATMENT"[., }SEPTIC TANK Es:}� +`�'" ize__ _ L'iq`uid RDept / I <br /> ZY f T' T j l 1 Gi ! y <br /> Ca -cit _ Materia - No. Compact etas.__ __ <br /> P, OY -' TYPeI�LC� ; <br /> I3 <br /> D1s.ante}to-near-est::Wel1--_:::_------ Fac�ndation- --- Prop, Line-----S ___------ <br /> # <br /> LEACHING LINE' [ No. of,Lines-_�----------- ------€Length of.each .line.__. ' -/' DJ .. ..Total-.Length. _._l_L _______:_______.__ <br /> a t } <br /> t it 'D' B221t <br /> >f,,.Type Filter Materizfl&+� Depth Filfer'rMateriai..__� -- -_ . - ------ __-i- <br /> X <br /> i - ..o nearest: Well " �_ ° _-Four%datlon �_�- Property Line-'� -------- <br /> SEEPAGE PIT ( Depths .__ _. Diameter � ` ' '� ? <br /> _. __ Number Rock Filled Yes <br /> Water Table-Depth' -----�--- Rock Size- ��-�3-------------------- <br /> R k5 <br /> Distance'to nearest: Well__,.._.��?�_._ _.____.___ --Foundation._/._d_._.._._.__#_Prop. Line_._�� <br /> REPAIR/ADDITION (Prev.,Sanifation-Peimit - ------ - - ---- --- ------------------------------------ <br /> Septic <br /> _-=--- -----} <br /> s� '- -- ......------- ................................................ ---=-- ---------Se tic Tank 5 self Re uirements�-� __-:`_::___.:•_ _____________ ___________ _P ( P Y qDisposal Field(Specify Requirementsl- ------------- ----------- --------------------•----- = =- - - --------------------- ---------- ----- -----------=---------------------------------------------------------------------- - --- - ---- - ----- --------------------------- ------------ -- - --- --{Draw eisting and required addition on reverse side) <br /> I hereby certify that I have prepared this application and'that.'the work will be done-in accord <br /> anc.e-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 certifies4he following: a <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 Califo'rnia." <br /> Signed-.-- = ---------=------------------------------------ --1- Owner <br /> BY; Gl.- ------- ----- --------- -- - -- T' ; <br /> tie <br /> (if other than :owners <br /> 'FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------_-----_ '� ------ �- <br /> ' - -.f--__..-=-----= -- --------- ----�------- - - ----._:_ DATE.--- ---�-- -- ---�J____. <br /> -- -------- -- <br /> DIVISION OF LAND NUMBER. - - ------=------ --------- ----------DATE.------------------ <br /> ADDITIONAL COMMENTS.---------- -------- ------------ ---------------------------`--- <br /> 11 <br /> ------------------------------------------------------ ------------ <br /> ............................. - <br /> ------------------------------------------------ <br /> -----,- ---- -------- - ------ - ------------- ----------------------------------------------------------------------------- ------------ <br /> r <br /> Final Inspection by: . <br /> - '" -------------- ------- - --------- -----------Date <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT &5 21677 REV, 7176 3M <br />