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f FOR OFFICE USE: <br /> s . APPLICAT�N FOR SANITATION PERMIT <br /> ----- Permit No. _7l <br /> -' ;(Complete in Triplicate) <br /> - ----------------------------------------- ~ <br /> r Date Issued <br /> ---------------------------------------_-_------- T ii,PernAt Expires 1 Year From Date Issued <br /> Application is hereby;maO to'fhe San Joaquin Lac f Health District for a permit to construct and install the work herein <br /> described. This applicationis'ama�de in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .___Ig T_Z___, ______ _r1_ IV -----------L��- ------CENSUS TRACT __ -`__ _. . <br /> Owner's Name ------ �.I_l-�l•-------- --------CH_ S____T1 E1\J---------------------------------Phone ------------------------------------ <br /> Address � 6 � t------ � Q ------------------------------- City ' ��-C- <br /> ' � .. 257 <br /> Contractor's Name JE -.-FE .__ D =.'__- - -.License #<W2 Ph <br /> one <br /> t Installation will serve: f Residence;XApartment House-[] Commercial ❑Trailer Court [3 <br /> f Motel ❑Other -------------------------------------------- J <br /> ' ii <br /> Number of living units:____I_ .,-,fNumber of bedrooms ;.____Garbage Grindery�5- Lot Size ^�AEi4(C-r <br /> Water Supply: Public System land name --------'-------------------------------------------------------- ----------- Private <br /> Character of soil to a depth A3 feet: - Sand'[] Silt❑ Clay ❑ Peat.❑ Sanldy.-Loam •❑ Clay Loam � <br /> Hardpan;�Adobe ❑ Fill Material _1lr__a- 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,) <br /> i XI 4 X .-- <br /> PACKAGE TREATMENT [ ] ;,SEPTIC TANK [ Size_.�------------- ----------------------------- Liquid Depth __ ---------.----- <br /> _ 1 <br /> Capacity /Z©a___i Type ____________________ Material__________ No. Compartments .._:____ V <br /> , ,, arc....-�` � <br /> Distance.�to:7nearest:Well --------�_0---------------------Foundation ___�Q-____________ Prop. Line ._.._,7�___:___-_-__-__ <br /> LEACHING LINE [+�No. of Lines ---- ___ __ __ Length off each line.______�S f____- Total Length i__ --------- <br /> 'D' Boxy _ Type Filter Material n_8_C ---------Dth FlltMaterial _.__- --------------------t---_-___-•-1 <br /> Distance to (earest3;Wel I ____ Q___'"i` _ Foundation ___ _ " Property Line ____________ __�'�`___ <br /> � - ` -- ---- Pro ---- <br /> SEEPAGE PIT [� Depfih ! _-_------___`-Diame#erll_XU�.___�Jum6 r _____~'_ _� __- Rock Filled Yes No i❑ <br /> Water Table Dep#h -'--- � '----- Rock Size r ------ �r t <br /> Distance to nearest: Well __�QQ_____________________l�_ ___Foundation __-1D__� ___ Prop. Line ___S___.....___.._- <br /> REPAIR/ADDITION(Prev. Sanitation Pgrm'itR# _._________________-__-_-____________ __-{3ate--------------_--------------- <br /> ____1 <br /> Septic Tank (Specify Requirements) ----------- --- --- ---------------------------�-T------------------------------1--- -- ------------------------------------------ <br /> Disposal Field (Specify Requirements).._____-_,D _______ ,t I THR <br /> , <br /> ' s. <br /> (brow existingand required addition on reverse side) <br /> I hereby certify that I have prepared thW application and that the work will be done in accc,MdnceaLwith"San Joaquin <br /> i County Ordinances, State Laws, and Rule"%"Clnd, Regulations of the San Joaquin Local Health District:4Home,'awner or licen- <br /> sed agents signature certifies the followings• . <br /> i <br /> "I certify-that in the performance.of the vGork for which this permit-is issued, I shall not employ any person in such manner <br /> me subject Ip Workman's.'Com ensation laws of California`'w <br /> as to become p <br /> if <br /> ' � <br /> -------- OwnerSigned =' = <br /> BY Title ---- <br /> --------------(If other than ov nr) <br /> ,y JA y :-FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY:: ____ r <br /> NG PERMIT ISSUED =p �' '------------ -- ------------------ ----- DATE <br /> — -- .- <br /> ADDrFIONAI CUM'MENTS'- -----y- ---- ---------------------------------------------- <br /> . T-„�-'—�� <br /> ' _ __. k �i -- --------------------------------------- <br /> * -- - -- -c- ` <br /> -� 1 ; <br /> #1 ---------------- --- -- -- ---- ---- ----•---------------- <br /> yq yy- _ T s_ - -s. -- _ --- <br /> " _ -- -------- ---- ----- <br /> Fibal'.lnSpe Date ------------------------- <br /> SAN <br /> ------ ------- <br /> SAN JOAQUIN' LOCAL HEALTH DISTRICT <br /> • 1 ,68ll ev. ' :fax <br />