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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - 79 a <br /> _ Permit No....-..'--------��---- <br /> ----- -- -- --- --------- <br /> •----- (Complete in Triplicate) <br /> ..... Date Issued.. /,".!/-_ <br /> .................. ..Y.f .�..............--.. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Heaith 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 Rules and Regulations: <br /> JOB ADDRESS/LOCATION.- .., /C./E -----•.........5 /(� ------------ --------..............CENSUS TRACT........ --- ------- ........ <br /> �O /S 1/ It- <br /> Phone.---V6&,7 �D.._... <br /> Owner's Name............... ---..gulLf—�.-- ---- .--- .... ---- .. ...... -------------••------------------ <br /> Address...........' ,3oZ... Ea2Kl Y- --------------- ----- - ---------- -------- -------city------ 1-------- ............ -Zip--------- y60 <br /> f���15 SOi(15. --- 3 . 3. -Phone-. <br /> Contractor's Name....... ---------------� � ---�-----�--.... __...- �... - <br /> ...._... ..license #-G�__,': .. <br /> Installation will serve: Residence ApartmentJHousei'❑ Commercial ❑ Ttaile Court ❑ <br /> ....... _ .�. Commercial. <br /> _. �. _ .: <br /> otel ❑ Other_....... ----------------'----•----------- <br /> Number of living units:....-.. .-.Number of bedrooms--3__. .Garbage Grindw -�....:"=Lot Size:......... . . ..... . . ........... . ...... <br /> Water Supply: Public System and name ---:--Private ❑ <br /> Character of soil to a depth of 3 feet: Sand Q Silt❑ . Clay}EJ Peat❑ Sandy Loam [] Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material - - .. ....1f yes, ty'.pe---- ---------------- <br /> {Plot plan, showing size of lot; location of system in relation to wells, buildings, etc. must be placed on reverse side.[ <br /> -, _ _ Vu <br /> NEW INSTALLATION: (No septic tank or seepage p ,] <br /> it permitted if public sewer is available within 200 festo ` <br /> PACKAGE TREATMENT �[ ] SEPTIC TANK [ ] } Size ------------- -------------------- ---.Liquid Depth..__:___-.--------- ----- <br /> F" <br /> Capacity- ----- -------------Type---------------.--. Mat&i 'I _ No. Compartments <br /> el . , <br /> Distance to nearest: Well— _':_.....-.................._ __.. .-.Foundation----- --- - ------... :..Prop. Line----..---............. <br /> i <br /> r <br /> LEACHING LINE [ ] No. of Lines ............ .....: `....Length of each ling-----------=--.--- ------Total Length --- .----------- ------------ <br /> E XI�ST/,(16 'D' Box..... __....Type Filter Material.. ---.Depth Filter Material------- ----- --- ------------------------ - --- _. <br /> Distance,to nearest: Well------]--------... _.__Fou_ndation---------------------- ....Property Line...--------.......-......... <br /> . . <br /> SEEPAGE PIT [ ] Depth...... .........Diameter.........------.--.-Number -------- ---------- Rack Filled Yes ❑ No ❑ <br /> EX1S7-A)6 Water Table Depth- ------ ---------- -=..X.`=..Rock Size.- .......... <br /> _... <br /> Distance to nearest: Well--- -:..._- '......Foundation Prop. Line.........- <br /> , �� Y l <br /> REPAIR/ADDITION (Prev. Sanitation Permit#---:.-.. I-�_ 6. .._.. :.: `-.-..Date°----:-.- ..-7I. ......................] <br />' -- <br /> I Septic Tank (Specify Requirements]--------- ----------=---- --- ; <br /> Qf <br /> Disposal Field (Specify Requirements). ►----- ----- -- ...�8.x. ....1°�. <br /> ----- -•---- <br /> ................. ..---- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that�h.e 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 /> 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 as <br /> to become subject to Workman's Compensation-laws of California: , <br /> netSigned....--------- -------------- <br /> -/ 4�7-4W.Oc )W< ---- -- <br /> F <br /> (If other than owner[ <br /> FOR EPART ENT USE ONLY <br /> i_ APPLICATION ACCEPTED BY DATE .1�..7- <br /> -- ----- .... <br /> ------ <br /> k <br /> DIVISION OF LAND NUMBER. DATE _.... <br /> ------------------ ------------ <br /> ADDITIONAL COMMENTS-........­­- ...... .... <br /> ----------- -- ------.....- ------._.----- ------•-------..------------------- .....------- <br /> __ <br /> i _ r q <br /> �, o... .._.. --------- ------------------------------------------------------- c:l. ...1 _---- ...... <br /> Final Inspection by:... <br /> _...... <br /> E 8H 13 24 � SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br /> i <br /> i <br />