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v •Y' <br /> FOR OFFICE USE. � FOR OFFICE USE: - <br /> Y APPLICATION FOR SANITATION PERMIT <br /> ......... --------- - - ------ - - -_ Permit <br /> (Complete in Triplicate) r <br /> ..................................................... ..- <br /> Date issued/.L:,,1P--,75 <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 incompliance with County Ordinance No. 549 and existing Rules and Regulation's: <br /> ��� -� � �- � .-_-.CENSUS TRACT.-..-------------- <br /> Owner's <br /> . _ <br /> --- --- ....... <br /> J08 ADDRESS/LOCATIO - -----1�-- -- -------- ----- � --------- ---- c, � `L <br /> Phor3e_G-. .5^ _..T-...._. <br /> Owner's Name.--..--._..: . 0 -- p. <br /> Address Cit / 'H r <br /> Contractor's Name-..... Jt S-07 Q1.... License # � �} _. -Phone. � 07 <br /> Installation will serve,: 'Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other.........--- <br /> Number of living units;..--_.._.._.Number of bedrooms...3_-. .Garbage Grinder------------Lot Size__--- ... - <br /> �� Private <br /> ..Water Supp€y:.Public_5 stem and name... ............... - ------ --------- ------ --- ------ _ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat,❑ : Sandy Loam ❑ Clay Loam ❑ v ." <br /> Hardpan ❑ Adobe Fill'Nloterial.. .... . - If yes, type----, ---- <br /> {Plot 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,[ !r <br /> PACKAGE TREATMENT [ ) SEPTI ANK N ---- <br /> r ! <br /> . - --- g p <br /> th­ <br /> aci -------No.- Compartments----- <br /> ----�. ... . .---- <br /> ..-- ...Cap ` / � ._ Type-�------------ . . Matarial. <br /> � i � .(47, <br /> r .. ...Prop, Line-.S' <br /> ineri�- '..Distance to nearest: Well... ....... ....... .....-Foundation.--- . ..... ........ <br /> LEACHING LINE A No..of. Lines �. +'..-- ..----.Length f each line ---- I -- Material l Length... <br /> ------- <br /> ..._- g <br /> ��/} Total Len t <br /> D' Box'-.. Type Filter Material. <br /> -_-.Depth Fit M �_- <br /> pY . .............:... <br /> �", . I :__f_..- Pro Cert Rock Filled Yes No ❑ <br /> Distance to nearest: Well-- ............ . Foundation-_._ <br /> r r <br /> SEEPAGE PIT Depth.,;ZA...-...Diameter_--._1?. ------.Number...---a�------------------ --- <br /> rl <br /> Water Table Depth--------------- --------------- - ----.Rock Size- <br /> *. ----------------- <br /> Distance to nearest: Well--------- --------- f .-----Foundation.....f.).---1� -.Prop. Line-., _. ..... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#___-------- ---------."------- ---------------pate__:--_--_.---- --- j <br /> ------- ---------- ----- <br /> Septic Tank (Specify Requirements)---- ----- ------- ---- --- 6 <br /> .Disposal Field (SpecifyRequirements)---------------------° .................. --- - ---- =------ - ------- <br /> ------ ---- ----------- i <br /> ::. ......- ----- • ----------------------------------- - :. ...... <br /> , _- - rte,,,,,:• ._,,, ., < �::-Y-�-:�= _�..;:. <br /> .............. ._------------- --- --- ----- ---- ----- - ----- <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 .Rulei and Regulations of ,the. San Joaquin Lotai Health District. Home owner 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 ds , <br /> to become subject to Workman's Compensation laws of California. <br /> Signed.---- :..... .... - . --Owner <br /> BY . ....... -._. ----- Title..... -- <br /> ----- ---- -- <br /> 6 <br /> (If other than owner) <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- --DIVISION OF LAND NUMBER.__°. .... ..DATE.--. =:.... <br /> ADDITIONAL COMMENTS-- --- .-.-.. ' s.. <br /> l" -- - - , <br /> ------ -------- ------------------ --- <br /> -- ---- ----- -- <br /> - ....d ----.ViC ---- ------------.- <br /> --- <br /> 1 , <br /> - ------------ ---- ----------------- ---........... te. <br /> final Inspection by:.. �� ' ------ -------- ------------------ Da ie rm <br /> + / F&5 2 77 REV. 7/7h 3 <br /> EH 13 24 SAN JOAQUIN,LOCAL HEALTH DISTRICT <br />