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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -- (Complete in Triplicate) <br /> Permit - 7_/A__ <br /> --------------------------------------------------------- <br /> - Date Issued <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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> w f - -Q//CENSUS TRACT <br /> t JOB ADDRESS/.LOCA ION._.��;--`�-�- ' - --� � -- --i- ---�--- --- -�-,- �- ' - � - <br /> � .; "-------------------------------- -- <br /> - ? -----Phone <br /> Owner's - " <br /> - - i - <br /> Address. .: L -' ; ' ra 7/ Ph ZAP <br /> Contractor's Name--;' �Ule -------_ --------------License # <br /> Commercial Trais <br /> - --------- --- - <br /> Installation will serve: Residenc;11M�110 <br /> Apartment House.❑ ler Court:❑ <br /> ; ...�;._.._i... `� tel ❑ Other ` -------- <br /> --- <br /> : � I: _. .r y <br /> Number of,living units:______ .___.___Number f b drooms__ L.-Garbdge Gri ex._/!!__ __Lot;Size_____________________ ' <br /> �, <br /> ----------= ------ --------- <br /> Water Suppiy:•Public System and name KC <br /> j y�.----- - --------------------- Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ SiltPeat ❑ Sand. Loam 'Clay Loam ' <br /> Hardpan Adobe Fill <br /> -------------------------------- <br /> (Plot <br /> Y ❑ .. .-y ❑ <br /> ill Material_..:-- -----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 /> ge pit permitted if public sewer is a ailable within 200 feet,) j <br /> NEW INSTALLATION:' (Nolseptic tank or seepa Size_. --- ---------------� L�----Li Liquid De th_ � r <br /> PACKAGE TREATMENT' [ ] SEPTIC TANK [=l q �---------------------� <br /> o. Compartments..: <br /> Capacity-- fj,"VeT,pe Material ----------------- <br /> 'Distance to nearest.-Well.'.----- •... -_=`-- on �----- = :- Prop. Line V <br /> �-�— Foundati <br /> 'LINEs [ ] No. of Lines __- Length of each line _.__-14 :" Total Le f!___ _ <br /> '---------- <br /> LEACHING <br /> D' Box- -,/-:--Type Filter Mate'rial_ �L-Depth Filter M eria�-----____-"/-- -----------------=---------------------------. <br /> Distance.to riearest: Well- _--_ �• T Foundation_ .___ _ __Property Line----- ___._________ <br /> SEEPAGE PIT [ ] Depth_- <br /> Diameter- -- umb ---------------- <br /> Filled Yes No ❑� <br /> �• •� �"` "` ------ _0- --- --' ize --' ------ .------------ --- -- ' <br /> Water Table Depth:___. .� <br /> Q-- _ Rock S' � --- <br /> .. <br /> Distance,to nedrest: Well'' :Foundation Prop. Line _ <br /> t ° _-' - ' <br /> it <br /> ---Date------ - ---------- ----1 <br /> REPAIR/ADDITION {Prev. Sanitation Permit#____.'___'_`_________________. __,.___._ •..-�-. <br /> Septic Tank [Specify Requirements)___--=------------------------------------ ---------------------------------- <br /> DisposalField (Specify Requirements)----------------- --- ---------------- --------------------------------------------- ----------------- ------------------------------------------------ <br /> f a ` , <br /> --------------- <br /> ' ______... ______________________________________________""--_----_"._"_"""-"_____-"__._"-----_--------"- --____------------------------------------------------ <br /> --------------- <br /> -_.__._------ ---_-__-.______---- ""---__._.._-------.._.-_____ <br /> "-____---_. ______. - <br /> .. • k [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 age <br /> signature certifies the following: j <br /> f "i certify-that in the performcince of,the work for which this permit is issued, I shali' not eiiiploy any person► in such manner as <br /> ! to become subject to Workman`s Compensation .laws of. California." <br /> Sign --- - -------''°" -.-.------:Owner <br /> �. <br /> .. � --- ---------------- ` <br /> By- <br /> Title <br /> (If other than .owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY__::---, ------------------------------------------------------------------------------------- QATE. ----- <br /> DIVISIONOF LAND NUMBER.----------------- ------:--------------- .-----------------------:--- -- ------------- :.: -----------DATE ' <br /> ADDITIONAL COMMENTS- - ---------------- ---------------- ------- ------------- <br /> -------------------------------- <br /> 7.• _ __ ----_ _ _ ________________ - - .._"-_____-_._____ - __ ---"-__.___----- -._____.._-__ <br /> "---------------- <br /> Final Inspection ---------- - _Date-�T �--- ---'-- <br /> pY -------- ' <br /> FH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7/76 3M <br />