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FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit <br /> 0 <br /> k Permit No.,?e_��3'�-3_ <br /> ----------------- ---------------- -------------- <br /> A (Complete in Triplicate) <br /> Date <br /> sue <br /> FOR <br /> Is------------------ ........... ----------- ...... <br /> ............... This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Son 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.Ruies and Regulations: I <br /> Ju.....004"-CENSUS TRACT__..................... ...... <br /> JOB ADDRESS/1-OCATION--j"SIVO <br /> Owne'r's Name...Aelc ------ ........... n J6 A6. <br /> ----------------------- <br /> ..Zip--------------I--------- <br /> .......... ......... 'City__.Z:a�44........ <br /> Address--.-.—5.1 me......... ------_........ ...................... ----------- <br /> Lice' s Phone.VQ1l...-9 <br /> 400-77-... <br /> Contro6or's Name eZ2........WAAAe��40k... ----------- ------ -------- :License # <br /> Installation will serve:' Residence Apartment House 0 Commercial ❑ Trader Court <br /> ❑ <br /> Motel El Other.__.. ...... <br /> ..Lot Size-/7r. X_/510—................ <br /> Number of living units:.... ---------N u rmn r of bedrooms...?.....Garbage Grind r Ew A0. <br /> .Private <br /> Water Supply: Publj�System and name.. ------ --------- ...... ....... ----------- ---- ----- ----- <br /> li----- -------- ----- I ' ' '�/i <br /> Character of soil to a..depth of 3 feet: L.8and [:1 si It E] Clay 0. Peat ❑ .4,Scindy Loam Clay Loam ❑ .. . . . . <br /> t - <br /> Hardpan ❑ Adobe F] L. <br /> ---------- <br /> Fill Materia .-- — <br /> ..If yes, type:-: <br /> laced on reverse side.) <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, <br /> must be p (A <br /> NEW INSTALLATION: (No 'septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> - - . .. - - -- <br /> PACKAGE TREATMENT SEPTIC TANK Size ---------------------- <br /> - -- ---...Liquid Depth.. .. ... - --- ---- -----tZ� <br /> P_No. Compartments.--- <br /> Capacity/,goo.......Type$ A.- Material.670�C-A <br /> Line. <br /> WelL.... ..-Foundation.. <br /> Distance to nearest:; �.7 wo *4 <br /> 1 /_------------'-..Length of each line -----------------Total Length .7.7------- -- - ---------- - <br /> LEACHING LINE No. of Lines........ <br /> 'D' BOX../ ..... 'Type Filt'-e"r'-Materia4)A;A-444rD/ei:p)k alter Material.- --------------------- ........... <br /> ------- Property Line...—5.74------- <br /> Distance to nearest: Well_,,516­_ -----.Foundation-- No. <br /> I Roc'k Filled Yes [7] <br /> &E4149 k19f--RtT De ...4a ------ ---.Number ------L•-------------- ------------ Awn <br /> X "'i <br /> Depth. # <br /> ❑ <br /> Rock Size <br /> Water Table Depth.........*,1_0-4_ ----------------------- -------Roc <br /> Prop, <br /> A0 ion <br /> _+ -------Four��t <br /> Distance to nearest: Well----- ---` <br /> ..Foundation.... .--- Pro Line.. <br /> REPAIR/ADDITION <br /> ell----- <br /> REPAIR/ADDITION (Prev. Sanitation Permit ........ <br /> .4464C_Date---------- <br /> Septic Tank (Specify RecIbirernentsl ....P_%FwAve, 01e4—n- <br /> ---RV -------104 <br /> 11111V <br /> Disposal Field (Specify Requirements) ......­--------- --------------- I------- --------- --------------------------------- ----- <br /> ......... ..............I............. ------- <br /> 1, �4 ­­.... .......... ------ - ---------------------- <br /> --------------- i 1�------------------- -------- ---------------------- .......... ...... --- ------------------------ ... ........ <br /> ------------------------ <br /> ri�quiried <br /> -(Draw exisfing an addition on reverse side) <br /> accordance with San Joaquin County <br /> .1 hereby certify thcitl have prepared.1this application and that the work will be done in Home owner or licensed agents <br /> Ordinances, State 'Laws, and Rules and Regulations 'of the San Joaquin,,Local Health District, <br /> ,signature certifies the following: <br /> i <br /> `�l certify that ini the performance of'.'the work for which this permit is isswid, I shall not employ any person in such manner as <br /> to become subjet4*16' Workrridn's Compensation laws of California." <br /> -------- <br /> Signed-..... .. .......... --------- ------------- ---- - <br /> Owner Title_... ...... ------ --------- - <br /> By----------- -- ------ ------- ------------ --------------- <br /> (if other than 'Owner) <br /> MR DOARTMENJ USE ONLY- <br /> -------------- .......DATIE <br /> APPUCATION ACCEPTED BY.;----------. ... ..... ....... <br /> ' ----DATE...-.-...... ........ . ...... ......... <br /> DIVISION OF LAND NUMBER.....------- .......... ...------ .I--------- -­ ....... ...... <br /> Il'OADDITIONAL COMMENTS- ........ .......­------------------------- ...... ....... ............... -------- ----------------- ------ <br /> ............. .............. .............. <br /> ------------------------- ----------- --- ------ <br /> ------------------------___-------- ------ <br /> .......... ........... .......... ........... ............... <br /> --------------- -------------I--- - --- ------------------I------------ ---------- ------------------- - -------- <br /> --------- "Ci6fe . ...... ...... . ... <br /> ------ -- - - <br /> ---- <br /> --------------------------I......-------------------------- <br /> ..... ........I------ ------------ P_wl <br /> Final-Inspection by:- .... F&S T677 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />