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FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> 10 Permit <br /> -- -------- < ---- ------- --------- ---- (Complete in Triplicate) <br /> -Jy( ---------- <br /> Date Issued.-.�-=��-- <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 Ordinance No. 549 and existing Rules and Regulations. / <br /> C N1n�T�CIa - ---CENSUS TRACT -- -- -O?-------- <br /> 1-J'�CG1-° --------� - <br /> JOB ADDRESS/LOCATION,.=-,-- --.J :--------- - <br /> Name. <br /> f'1�!�C} 1- - C K2�S'T - --------- ------------------ ------ --------- <br /> elPhone <br /> Owners . .,,.. ::...... .. -Z 5 <br /> ;. T City 'P , <br /> Address ------ -- ----'--- ----------------- ------------ -- - -: - <br /> Co tractor's Name. ---��1----- ------ <br /> r _ License #._ Phone.. - 2-' ... Y <br /> Inslallation.w' ill•serve: Residence ] Apartment House E] Commercial F] Trailer Court#E] <br /> r Mote! ❑ <br /> Other- = = t <br /> �� e Grinder. -.Lot Size .--.---- <br /> Nu� ber of living,units:-..- Private <br /> Public 5 stem and nameer-of bedrooms_.----. _=--Garbag - <br /> Water Supply; y <br /> k Character of soil to a depth of 3 feet: Sand ® Silt ElClay ❑ , Peat❑ Sandy Loom ❑ Clay Loom El:Hardpan ❑ . Adobe ❑ Fill Material_..---------I.f Yes, type---:------------- -------------- i <br /> (Plat 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,) k <br /> PACKAGE TREATMENT-:[-] -SEPTIC TANK [`] Size------------=•-----: = LiquidP <br /> th <br /> ,. opacity.---- ----- YP <br /> e = ---Material--- -------------------No. Compartments"-- ------------------------------- <br /> ------------- <br /> --------- ----- -------�--- <br /> C'� rte _ Foundation--- ---- �- Prop. Line- -- ------ <br /> Dist to.near.est: Well.. - v <br /> ` r �✓ <br /> No. of Lines.= " :--- Length of each I.ine.-_.-.-"- -- Total Length.,_.__ <br /> 'I'E ACHIN r4N �['] E <br /> f; = --- Depth Filter Material <br /> - --- . <br /> �„ ox - -- -Type Filter Material .. <br /> � � _ . _.. ",Pro Property Line------------- -------- ----=--- <br /> Distance•to nearest: Wel l-----.._------------- -- --Foundation .-_-.._---------- --_-- P Y <br /> ,.. <br /> De th_-______--`- - Diameter------------------ <br /> SEEPAGE Rock Filled Yes ❑ No ❑ <br /> PfT [ l P - <br /> '. P = = dumber-- -- -------Rock Size----------------------=--- -- <br /> r <br /> Water Table'De th-------------- - <br /> oun ation-- ..' - r 1ne. ------- --------- <br /> -i5lnce-to-nearest Well------- -------- F doP <br /> 4 , , --------------------------------------- <br /> -------------- -----------'-----^'-__) <br /> r n f... Date_ <br /> .: _ <br /> REPAIR/ADDITI�- N (Prev. Sarrtation P�rmit*-.---------- <br /> r <br /> Septic Tank {SP]c• Y q - -------=-- -------------- ----------------�------� =--_--.--- -------- -------------------------------- <br /> ----------- <br /> PP <br /> Disposal. Field (Specify ltegl,i'rements) - A �'� `7 <br /> - <br /> . -�-Y51 ------ ------------- ------------------------------------------- <br /> ------ <br /> ------------------: . .--. - ------ - � <br /> -- - <br /> = = ----- ------ ---------------------------------------------------------: ---------------- . ----- ------. <br /> - ------.------•------_- - s <br /> - (Draw existing and required addition on reverse side) r <br /> I hereby certify that:l have prepared this application and that he work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws; and Rules and Regulations of thelSan Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: a <br /> "i eertify thrat iri the perFormartce of work for which this permit is-issued, .I shall not employ any person in such manner as <br /> to become subject to. Workman's.. pensation..laws of. Ca!,ifornia." �~ <br /> _ -- -------- ---- --. <br /> Signed -------_- <br /> Owner <br /> ' Title : <br /> - - <br /> (I'f other than:owner) <br /> ► 'FOR DEPARTMENT' SE"ONLY r <br /> APPILICATION ACCEPTED BY-" <br /> - 0�?. DATE - ------- <br /> DIVISION OF LAND NUMBER ------------------=-------------------------- ---------- ---------.-------- ------ <br /> - --------DAT -------------- ---------------- ------ <br /> DIVISION <br /> ---- -; <br /> 0-&11- ---------- �i•-------- ------- <br /> f <br /> AD6ITIONAL COMMENTS-----=---- � _ ----------------------------------- - ------- <br /> --- ---- ------ -. ------ ---------------- <br /> - - <br /> _ i <br /> ------ ---------------------------- - - -. <br /> ----------------------- Y : _:_- ' - ------- - - <br /> � � - ------- �� ---- -------- ---- ---- --------- ----=-=Date.-�:�--�r+=- ---- <br /> = /�!/ - - <br /> Final Inspection by:_ - F&s 21677 REV.7/76 3rr <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />