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46. <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> �o APPLICATION FOR SANITATION PERMIT <br /> Permit No.7_� <br /> a (Complete in Triplicate] M <br /> Date Issued__/-.T_7 <br /> --------------------------------------------------------- This Perm it.Expires,i 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 dinance No. 549 apd existing Rules and Regulations: <br /> ., .. <br /> JOB ADDRESS/LOCATION - ��---- _ r___ .Y. - . ----- ".___.CENSUS TRACT.°''' <br /> �- - = ` <br /> �� - �h�Owner's Name.---------- ---------- --------------------------------------------------- --------- - ----- <br /> ------ -------Address �� _ - ~W City ---- - - Zip <br /> Contractor'sm �_ N - - °�- - ---=`--license . 7"�.5 --Phone- - --- ------ ' -d--- <br /> ------°- <br /> Residenc ❑ Til Court'❑Installation•will serve: euseommercaA - "°ofef" <br /> .' <br /> 1. <br /> el F <br /> ti <br /> .i <br /> f <br /> Number of living units:-."- -"----.__-Number of bedrooms-"--- _____Garbage".Grin R ' /A -------------------------------- <br /> stem <br /> of <br /> - Sze-------------- - ---------------- _-"- ---- - w <br /> Water Supply: Public System and name11 <br /> - ' t =- ., 1 "Private <br /> Character of soil to a depth of 3 feet: Sand ❑ 'Silt❑ Clay ❑ Peat-� San y Loam Clay Loam ❑ <br /> Hardpan ❑ AdobeV Fill Material__..___._., If yes, type_______- "--_"--_"---_______- <br /> [Plot plan, showing size bf lot, location of system in relation to wells,-buildings, etc.'must be placed on reverse side.) <br /> NEW INSTALLATION: - ' , see pit"permitted e No`se tic tank or !' <br /> { p seepage p permitted if public aewerlis available within 200 feet,} y - <br /> PACKAGE TREATMENT ` <br /> [ ) SEPTIC TANK [ ] Size -----------------------] ---Liquid Depth ,.---- <br /> i.---------------- i <br /> i Capacity------------------- Type--------------=--------Material---------:---------------No. Compartments-- ------ ----------------------r <br /> Distance to.nearest: Well----------------------=------- -------------Foundation------ -Prop. Line---------------------- <br /> LEACHING LINE [ ] No, of Lines:-",--_ ._--__---------------Length of each line-----------k_--------------------Total Length.-"---- _ ------"---_ <br /> `D' Box------------Type Filter Material"--- ---"Depth Filter Material----------------------------------- ---------------------------- <br /> Distance <br /> ---- ------------------Distance to nearest: Wel L:-------------------!---._-Foundation-------- _Pro ert Line <br /> SEEPAGE PIT [ ] Depth--------"-------Diameter--------------------Number---a---------------------------- Rock Filled Yes ❑ No <br /> i <br /> � Wafer Table.Depth --------------- -------------[----------=--------Rock Size------------------------------------------------ <br /> .�. <br /> t Distance to nearest: Well__----"------------- --- -- -----Foundation----------_ -_.Prop, Line -------"-- --- <br /> . F <br /> REPAIR/ADDITION {Prev. Sanitation Perrmit#---------------------------------------------------pate---------------_------------------------= <br /> Septic Tank (Specify Requirements)__.- ? _.__ _ -. _. w_µ - - =--------------- - _ = .w <br /> -- ------------ - --__ ----- <br /> Disposal Field (Specify Requirements) - -- ----------- `c 2 q�cc _ -----".7 L <br /> ----------------------------------- <br /> r <br /> ----------------------------------- ----------------------------------------------- - <br /> -------------------------- <br /> Drw ex'isifing required <br /> lon <br /> Ie) <br /> I hereby certify that I have prepared 'thisapPIcation and that the work will bedone naccordance 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 certifies the following: F <br /> "I certify that in the erformance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> E -- California."--- <br /> to ecome„su6jes Work a�n's m ens on .laws.of <br /> Signed- ------ ---------- - -----awi ---- <br /> BY----------------- <br /> ------------------ - -- ----------------------------- ----- -_------------ ---- -------Tit <br /> e(If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- -- - ----------- ------------------ -------- --"------------------------------------- DATE. = <br /> DIVISION OF LAND NUMBER - ----"-- -------------------------------------------------------"-------- DATE.------------ ------ ---------- <br /> TINAL CONTS ------------ ------ -- --------------------------- -------------- " <br /> Y <br /> �- --------- --- -- -- -�-"------------------- -------=---------------------------------- --------------------------------------- - I ------- ------- <br /> ------------------------------------------ ------ -------- - - ------------------------------------------------------------------------------------------------f ----- ----------------------- --- <br /> Final Inspection b _ _ ----------------------------------------------------------------Date.. <br /> EN 13 24 S <br /> AN JOAQUIN LOCAL HEALTH DISTRICT 4-21e77 Rev. 7h6 sM <br />