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FOR OFFICE USE: r_ FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------- i Permit No--- --- -= 7-- <br /> ------------------------------------ (Complete <br /> - <br /> (Complete in Triplicate) <br /> 4 <br /> - Date issued__. 7 2._ ~-____.._._ <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 applicatio m 4�1liq nce with C unty Ordinance No. 549 and existing Rules and Rgg-��Af A�la i <br /> (rpt V a <br /> JOB ADDRES /LOCATION.. -- _ -- �G---------- -- - <br /> ---------------- <br /> Owner's <br /> -JtN -_f�N_ ._ --CENSUS TRACT.-------------------------------- <br /> r r -------- ----- -Phone <br /> Owner's Name---A/�f--` .--- - -�-`v s <br /> � Q � l ---- ------------- City Zi <br /> Address ----- --�---�$ --------------- ----�-t- - �- -•-- � - ------ -- - -- p----------------------------- <br /> Contractor's Name------- -T_G1---- 1/_ 'a-----. - -----------------------------------License # _ 1 . •--Ph}one._ <br /> /// "`""" �� rcial ❑ Trailer Court ❑ <br /> Installation will serve: Residence MoteAp❑art Other,ause ❑ Comme-s_ - - -w <br /> Number of living units:---.- f Number of bedrooms. ,__Garbage Grinder l _Lot,Size_._-1-,4ct-'e--d914--J----------------------- <br /> Water Supply: Public System and name---- Silt la Peat Sand Loam Clq Loa ---Private <br /> Character of soil to a depth of 3 feet: Sand ❑ y ❑ ❑ Y ❑ Y m ❑ <br /> Hardpan.❑ Adobe r iWMaterial_- ---------If yes, type--------------------------------• n <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be - <br /> 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 ( ] SEPTIC-TANK "-^--Size-__=.�i� � <br /> -- y� " ''°`�_.�� Liquid Depth 7"�Z-------- <br /> � �j' I <br /> Capacity-J.'a-____Type. --.Material__ ______�_ o. compartments-___�_________---.-- <br /> I (1� <br /> stance to nearest: Well-------- __� _ ------Foundations_/0 -----__.-__.Prop. Line-517_______________f .r <br /> LEACHING LINE [. No. of Lines---,?------------------ Length of eachIl'ine. � 'y __.__.Total Length 1_-I ____--------------- <br /> 'D' Box.rtonearest-, <br /> -Type Filter Material--_ cam#___Depth Filter Material-..._ - ----__._--____________---------------- ----_. <br /> istant Well__---"_l____-r,_--.-Fougdation _a�--- _____� Property L"me_ r__________________ <br /> ti CFI <br /> SEEPAGE PIT [. Depth-c2-`S-_---Diameter_---_-----,----NurMber_-,_,__S-.r___________________ ,� Rock Filled Yes No❑ <br /> tf <br /> Water Table Depth `', --- ock Size l-_l _ Y- ----------------- <br /> Distance to nearest: Well------_ -- ` Q T /Foundation_----.--e/� l op. Line___�r--__-__-_-- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------- ------------------------Date.---------------------------------------1------} <br /> Septic Tank (Specify Requirements) ------------ = - <br /> Dis osal Field (Specify Requirements)----------- -- ----------------- '----=------------- ------------------ --------------- <br /> --- ----------------------- -----+--------'----------- `------ - ----------- <br /> t <br /> --------------------------------------- - -- ------------------------------------'---- 9* --------------------- ------- ----------------------- ------------:---------------- ------- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 SanAoaquin Local Health District. Homeowner 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." I <br /> Signed ------------------------- ---- - - --- --- -------------------------------- ----Owner � <br /> By------------------ - -------------- ------/� ----------------------------Title----------�/`! ............. <br /> .. i <br /> ( f of er than owner) } <br /> E <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.'--+------ '` DATE. <br /> .. <br /> DIVISIONOF LAND NUMBER --- ------- -------- --------------------- ----------- ---------------------- - ----------------------DATE.--- ------ ----- - -------------------------- <br /> ADDITIONALCOMMENTS---------------- ---------- ------------------ ----------------------------------------------- ----------- --------------------------------------------­-... <br /> ------- <br /> ------------------------ --------- ------ ----------- ---------------------------------------------------------------------------•--------------------------------------------=_- -- --- <br /> -------------------------------- - ------------------------------------- ----------------------------------------------------- <br /> Final Inspection by:. ----- -- - -------- ------ ---Date---- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 2�REv. 7/76 3m <br />