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- _ FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No..--.7- <br /> (Complete in Triplicate) <br /> . ........ ........ Date Issued.. <br /> ..._... .... <br /> This Permit Expires 1 Year From Date Issued <br /> .............. <br /> P �j <br /> plication is hereby made to the San Joaquin local Health District for o permit to construct and.install the work herein described. <br /> ,is application is made in compliance with County Ordinance No. S49 and existing Rules and Regulations: I. <br /> r-/ !/ .......... CENSUS TRACT........... ........ .... ..... <br /> JOB ADDRESS/LOCATION .....- . ..Phone. - S <br /> Nvner's Name ... ......_. /'/• . .•. .f ♦ �'��� p . ..._. <br /> �'S/: ... - - <br /> -- -:'-- ----.. city .. <br /> Address-.._. .�! <br /> e. � -�-License #................. ...... .. one....._._.--•-P <br /> ",ontractor's Name-_. ..Q'�!v <br /> ............. <br /> } Trailer Court ❑ • <br /> tstallation will serve: Residence Department House ❑ Commercial ❑ of <br /> Motel ❑ Other...... ..... •---• ............. ............. <br /> 0,0 <br /> 4umber of living units:. .... Number of bedroom 3....Garbage Grinder.•-•-•••- Aot Size. --- , Private ❑ <br /> �..:... <br /> .... .... ...... .. <br /> Voter Supply: Public System and name... .. -- ----- peat❑ Sandy Loam ❑ Clay Loam El <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ <br /> if yes,type �........... ........... ... <br /> Hardpan ❑ .Adobe ❑ Fill Material.- e.... - - _ <br /> side.)placed reverse <br /> s, etc <br /> (Plot plan, showing size.of lot, location of system in relation' rmwedsifbpub icsew~r is uvailst laable within,200 feet,) <br /> SIEW INSTALLATION: (No septic tank or seepage p' p liquid Deptlt....:._.I..... ..... ...... <br /> SEPTIC TANK [L4— Size....._.. <br /> 2D,949........ •-. S,---_-------- <br /> PACKAGE TREATMENT [ <br /> 1 --�-.Material..............•..... ....:No. Compartments............ <br /> ---••----��-- - -•- <br /> Capacity...... ..........---Type......... .._.. .. <br /> • Foundation... s . .............Prop. Line..... _......... <br /> Distance to nearest: Well />2p- - , <br /> .. 01 �..._.7 D•�_-.•....Total length .i.�2�••• .•• • •• -- <br /> LEACHING LINE [�NO. of lines....... _Len gth of each line...... <br /> � I T e Filter Ma eriitl.:...... ...........Depth Filter Material...-.............. .. -.,.---:........ ..... ..... <br /> ...... <br /> D' Box .... ... YP - <br /> - t � .Property line.:....- <br /> f, . .. Foundation...__- ,- •_- ._..... <br /> Distance�to-nearest:Well:.-la�--••--- Rock Filled Yes ❑ No❑ <br /> SEEPAGE PIT <br /> Depth.......... :....Diameter.-------- ....Number. .-- -------- --- <br /> l I ) <br /> .Rock Size.................... ........ <br /> Water Table Dep . �:R� ........._...... <br /> ....�- <br /> th_:.' .... ...............Foundation_. ........-.. . ..-.....Prop. ine............ . ... . <br /> Distance to nearest: Well-_-..-... ...... ) C <br /> Date...................... .........._..... <br /> REPAIR/ADDiT10N (Prev. on Sanitati Permit ------------- - ..-. .-....., <br /> ..........................:................. <br /> Septic Tank (Specify Requirements)..._ -.. ..-- -- _ :.......... .......... <br /> Disposal Field (Specify Requirements).-.. . :................I..................... <br /> - ..............•.......'...---- . ........... •----..._ ..- <br /> `� <br /> _------- --------•--- ----- <br /> .. <br /> ............... <br /> _s: (Draw existing and required addition on reverse side) <br /> once with San oaquin County <br /> k. .: rk <br /> I hereby certify that I have prepared this application andfi'herSan loaqu Joaquin al be dHealth Districtone in . Home wnerr or,licensed agents <br /> Ordinances, State Laws, and Rules and Regulations o ' • 4 <br /> signature certifies the following: to any person in such manner as <br /> "1 certify that in the performance of the work fair• i�+ich,this?hermit is Issued, t shall not emp Y <br /> -: <br /> to become • ct to W on's mpensotl'oihtl�ivvs of California." <br /> Signed......... r Title..'. <br /> :. .... - -- <br /> i' { <br /> e.... <br /> (if other than owner) <br /> r+g, _ <br /> i N ;; pOR EPART NT USE ONLY <br /> ti. .. ....... _ <br /> -. � ..7y'- .. . <br /> }:, <br /> APPLICATION ACCEPTED BY...-.::'_ _-___ E..-.- <br /> . ... p ..A .................. �----...... ... <br /> DIVISION OF LAND NUMBER. "..s... ....'_ .....:. �:,: -............ .... .......... <br /> ADDITIONAL COMMENTS- :: ' ' <br /> ........... ...... ............. .. ........ <br /> ._.... <br /> ................ ....................... _.._.. .... <br /> :.:....: <br /> ...............� .: `•` Date. _ ..... .. .... ..... .... .... <br /> ........................------ •..... ., .... . . ..............I..._..........._............ f6S 31677 REV.7/76 3 <br /> . . --•.. <br /> Final Inspection by:.... ....._.---. .. . - <br /> "�t<i w SAN JOAQUIN LOCAL HEALTH DISTRICT <br />