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• AOR OFFICE USE: FOR OFFICE 6SE.- <br /> . APPLICATION FOR-SANITATION PERMIT <br /> - <br />....................................................... IComplete in Triplicate? Permit N;,77, -•9-o <br /> ........................�......--------------._.1111... 3� ...' . . <br /> Date Issued f <br />....................................._............ ...... I This Permit Expires ] 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 Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIONENSUS TRACTY -.� L <br /> , y � �pOwner's Name.. [tK ' � -QT7c�tY 'Ada"ess <br /> C <br /> Contra r s'Name f' R License #.. cia' Phone ;' <br /> Instal latlon,will serve: p Residence Apartment House E] Commercial ❑ Trailer Court ❑ ,g: � <br /> otel ❑ Other..,.:---------- --•- ------•- --------- <br /> Number <br /> --Number of living units:.-_.."...._....Number of bedrooms- Garbage Grinder_. Lot Size <br /> Water Supply: Public System and name............. -' 'Private <br /> ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ `Clay❑ Peat❑ Sandy Loam ❑ Clay Loam Qy ' <br /> Hardpan ❑ Adobe Fill Material............If yes, type------------.................... <br />(Piot 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 ifpublic sewer is available within 200 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] ( µSize - __-.. y.:Liquid Depth <br /> .T e.--- -� -- - -Materia! -- Compartments."..._ <br /> . . ---•---- <br /> Ca acit ' 1111_.. 4 ' <br /> Distance to neares#: Wellp_. j[ f'�/�.Fouridatio NfoC.� rop Line_ ---•-- <br /> � n _ Prop.- <br /> LEACHING <br /> LEACHING LINE [ ] No. of Lines -. .: Length of each line .........Total Length -....... <br /> AL <br /> D' Sox._ Type Filter Material.::-- ..-Dept - liter Material-• <br /> Distance to nearest. Wel .............. Foundation- -- Property Line <br /> .. <br /> SEEPAGE PIT [ j Depth....: Diameter.........___.."--"--Number__"-_------••--------------- >RockFilled Yes'❑R N <br /> Water Table Depth.-_ _----_:-.Rock Size •• ....... <br /> �... .Pro a , , <br /> Distance to nearest: Well------- --------- % _.-.-------.Foundation ..--.--. p. Line- ____ ._ <br /> ................REPAIR/ADDITION (Prev. Sanitation Permit •......... _ ..pate __---. <br /> ] <br /> r <br /> . ,v.i �„ iJkti�'. .-. .: �,: '. e.• j . _':' ' <br /> Septic Tank (Specify Requirements) ___._ ____.....__ .............. ----- r.-1, - <br /> Disposal Field (Specify Requirements)._ ., <br /> $ P M Y <br />...................1.111..--••-•--•----------•--. "_ ..---....._...-------- -----••------1111--------------------------., .-•; <br /> - <br /> '[Draw existing and required addition on reverse side] r <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 /> signature certifies the following: ' y ' t <br />"1 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." 74 <br /> t _._ OTiwtleneS d r ---------- <br /> ----- <br /> t .., ,•- <br /> _.... ----------------------- <br /> By---_.. ...... --- - ---- .......... <br /> ` {If other than owner] <br /> FOR DEPARTMENT USE ONLY <br /> . = - DATE.APPLICATION ACCEPTED BY- . ...-.............•-- <br /> ............. -- ------ ---------- --•:DIVISION OF LAND NUMBER.:r_ <br /> 5 ,� <br /> ADDITIONAL COMMENTS i .- . . --- - � <br /> L rr - <br /> .............................z . <br /> ................................... .......•••........................-- -- ----- . .. <br /> _ b <br /> ' _... 111_1._... .......................�.___,• - __ __ •__•__�_ <br /> ­ <br /> ------------ <br /> -----------------------------------------------._.._...._....1111..____. •1111..• 11_1_1 <br /> .. ....._ - ----- --------­--- <br /> ------------- <br /> 7 <br /> --- ••---- - - <br /> ..............................••______•.-_--._........_....-_-- ........, Y. 1p ........_._.._...�... ___......... <br /> Final Inspii6on b ..................... at - _,... <br /> y..._..." - _1111.`------------ ----1111_":------..........-- -•-----•'--•==•--- <br /> D e <br /> - -�. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> v"�.�M'-a 3M <br /> M 71677 <br /> Eli 13 Zia _ r43 <br />