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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------ ...................... Permit <br /> (Complete in Triplicate) <br /> ------------------------------------ -- <br /> - "" Date Issued.S'.A?-�-?-� <br /> ...................................... .................. This Permit Expires 1 Year From Date Issued <br /> 2S3- 12-0—Y7 * <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 complionce,with County Ordinance No. 544 and existing Rules and Regulations,AllM i <br /> JOB ADDRESS/LOCATION----------..f-------._.. l? �� �.....__7..��i�w�c`".. CENSUS TRACT..------: <br /> Owner's Name.....14 `---- Phone... .":1`'� 1....... <br /> Address--..--. -1r.6 r... A-- -7---- City..� i <br /> ..... <br /> Contractor's Name._--,G,.-. U�.� --------------- .................... License #, <br /> Installation will swve; Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ h <br /> Motel ❑ Other------ -- ---------------- -•-- ----- <br /> Y <br /> I <br /> Number of living units:...:.. ........Number of bedrooms......Garbage Grinder----_.....Lot Size---------��-'� --.. ;;.-- <br /> Water Supply: Public System and name------- --------------------- --------------- -------• •----- ............ -------------_ -------.---------------------Private s <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ ; <br /> Hardpan ❑ Adobe ❑ Fill Material.. ..._ ....if yes, type...,.__-------.. .. <br /> (Plot plan, showing siie of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 0`15 <br /> NEW INSTAL;ATION: (No septic tank or seepage pit permitted ipublic �r is�available withi�Ig00dfDepth'-­ <br /> PACKAGE u" <br /> TREATMENT [ ] SEPTIC TANK j ] Size_ <br /> Capacity/�,�.-{7----- Type �..0 57 Material--------- ---------------No. Compartments , <br /> Distance to nearest: Well./411-0- -_------.----.---------Foundation.�-Q.�`.. Prop. Line_7..S.P-.---- ' <br /> - <br /> �a t? �T <br /> LEACHING LINE [ ] No. of Lines ..."A..................Length of each ling._.., a-��-. --Total Length .. - _-. <br /> � ll <br /> i 'D" Box... ... Type Filter Material e6�X��Depth Filter Material..---- / ... _----------- - ------- ----- <br /> Distance to nearest: Well./'V�-----"-----.Foundation.! -............`....Property Line----. d....... ............ <br /> SEEPAGE PIT [ ] Depth.... ...__---Diameter--------------Ir.. Number-.- ---------------------------- Rock Filled Yes ❑ No ❑ <br /> r < <br /> Water Table Depth----•--------•----------------------------- ----•---- .Rock Size. - ;wF. ----..------ \fin <br /> Distance to nearest: Well---------------- Foundation ----..--- ..Prop. Line,..... <br /> :-.------.--.......K� <br /> 1 <br /> { / , ' ) - <br /> REPAIR/ADDITION (Prev. Sanitation Permit# ----•----------------- ----- -..........-- e. --.._... ------- --- ---..--.-- <br /> Septic Tank (Specify Requirements)----------- -------------- ..--. ---.---- - -' <br /> R <br /> Disposal Field (Specify Requirements)--....................... .... -............. . ' <br /> -------------- -------- ---------------------------......... <br /> -0`l' - <br /> [Draw 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 /> I; signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shell"not employ any person in such manner as <br /> to become subject t ��!r:�Kman <br /> ' Compensation lows of California." <br /> j Signed--- f' . ....__.... ------ <br /> ---------------- Owner <br /> BY- n <br /> Title ---..._ ------ ------------ - <br /> -- ------------------------•---------------- ------ <br /> (if <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY <br />( -------- .- .. ._-... _. ........... <br /> APPLICATION ACCEPTED BY ----------- - <br /> DIVISION OF LAND NUMBER.-- ...........--,.---------. --- -DATE--- -------- <br /> ADDITIONAL <br /> -----ADDITIONAL COMMENTS. - -- ----- --- - ----------- --- ---- <br /> t ----------------------- ........ --------- ........ _.... ..... <br /> -------- ----- --- --------- ------------ ------ <br /> .....------ --------------- --- ------------------------------- <br /> "--------------- ------------------- ------ <br /> Final Inspection 6 Date -.--.=12- - <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 2Fb�y,Cv. ���e 3M <br /> EH <br />