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F,�R OFFICE USE: _ / FOR OFFICE USE: <br /> f� APPLICATION FOR:SANITATION PERMIT <br /> -------`- ---------------------- - <br /> (Complete 11h Triplicate) Permit No.----- --------- <br /> ---------------------------- <br /> ----- <br /> ----------------------------s,------------------------- fy . <br /> 1 Date Issued-- <br /> -­----------------- <br /> ssued_. <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 Ordina/nncce'1No. 549 and existing Rules and Regulations: <br /> JOB AD17RE55/LOCATI N.-.--..SX 4' x r =i- �� '- - McNulSUS TRACT ----'-- --- - <br /> Owner's Name-: --- of <br /> =AddrPhone--------------------- ---------------- <br /> Address------ <br /> ess------ '�`----- ---- --- -- ----------.Zip---------- I---------------- F <br /> _ <br /> Contractor's Name,/, 4 h"-,,4'-- '` .L. Pay---�-license #-aZ-C 74:'7_-'�Phone�,�J .a'_._Q__�. <br /> � �. . lV�otel Other„ � _ . <br /> Installation will serve: Residence Apartment Nouse.❑ Commercial ❑ Trailer Court. ❑ <br /> ❑ g = Lot <br /> Number of livingunits:--'--/: of" edroo s_ Garbe a Grinder__- 5ize_._ .- ._., _. _._�___�__- j_.__.-;._- r <br /> Water Supply: Public System and name = ------------------------------------------- Private ❑ <br /> Character of soil to a depth of.3 feet: , Sand ❑ Silt❑ Clay D. Peat❑ Sandy. Loam ❑ -Clay Loam ❑ <br /> Hardpan ❑ ' Adobe's Fill Material.. ........_If yes,'type-----------------_____.._...__- = <br /> 10 <br /> (Plot plan, showing size of lot, location of system in relation towells, 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,) i <br /> PACKAGE TREATMENT [ J SEPTIC TANK J Size___ r <br /> - *1- Liquid Depth <br /> Capacity G la �TYpe Material- o. Compartments.-*�`=------ - -- ------ - <br /> _ 7 <br /> Distance to nearest: Well:: ______ _:____:Found'ation._ _ ______._ti___.____-Prop. Line_` _______ _________ - <br /> LEACHING LINE [� No. of Lines----------/-----___._-__Lengtb-of-eac -Iin®..r i .,_:_ T_Total Length__-_..Ia�___r <br /> --- <br /> jr <br /> 1 D' Box__" '_Type Filter Material- p r - -- t <br /> De th Filfe`r Material____ <br /> Distance to nearest:KWell .: .Foundation__ ___ _____________Property Line-.-'U--------------t <br /> ------ Y <br /> SEEPAGE PIT ___ _ Depthi^______Diameter- - Numb'er____:/�____.=_______._ A Rock Fi11ed Yes" No <br /> Pd <br /> t ❑ <br /> „ =Water Table Depth ��r ----.---.Rock Size f` `�-Y- I <br /> - _ <br /> .. ''-r.,,:ter? <br /> _Foundation____ <br /> Distance to nearest: Well--`-A& .��1 _--_-:- fe _--_:-°__--..Prop. Line-___ '---- - ------- <br /> :1 <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--: _________________________ <br /> Septic Tank (Specify Requirements)----- ---- ----------- -----------------------------'-------------------- ------------ x ---------------:------ _----_-- - <br /> Disposal Field'(Specify Requirements)--- --- ------ ------------------ ----------------------------------------------- ---- L y= ------------------------------- <br /> K"11 K" <br /> - --------- - - -- - - -- - <br /> = ------------ - - -� - -- ------- ---- -- - - <br /> k;I ' {Draw existing and required addition4on reverse side) 2Iheebycertify <br /> that 1 have prepared this'application and that the work-will-be dome inaccordance`�with-San_Joaquinunty ` <br /> 3 <br /> Ordinances,- State fla1.ws,' and Rules and; Regulations of th-,' San Joaquin Locgl-Health District, Home owaeor licensedgents <br /> sig'ature certifies the following: -47 <br /> "I cern that in "tom p P Y Y P <br /> fy ,performance of'the iwork far which phis; ermit is!issued�hshall not em to an erstn in such manner as I <br /> Signed to meg jec Workman's .Compensation laws] Cbliforn � f}� a � � d ••� �.L.n wA ' <br /> f ) eN <br /> c Ya 5 � "�JLv� <br /> !F <br /> t <br /> Of-other- owrierl YY_ L Rr1VI � k <br /> SEPTIi & SEWER <br /> 2113 So. Ora � ,S o�Isto. Calif. 9 <br /> FOR DEPA MENT USE ONLY <br /> A0PLICATI0N-ACCEPTED-BY= w ._v_. �-- --- ----------- ------ <br /> DIVISION <br /> -E '�[u r 1 ], <br /> VI! �cic.� 26 <br /> .A <br /> DIVISION OF LAND NUMBER --------------------------------- ------------ ---------- ------ ---- -------------------------------:-----DATE ---- -- <br /> ADDITIONALCOMMENTS------- ------------------------------------------------------------------------------------------------------------------------------ - -- ------------------ <br /> I <br /> -------------- <br /> --------------------------------------------- ------:---------------------- -------------------------------------------- ------- <br /> ------=-------------------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------- <br /> Final Inspection by:.--- -1 + -` - : _ _ T.- - - -_-------`= ---D 1 .� � j 7 <br /> 1 --- ate 111 1 <br /> r <br /> EH 13 24• SAN JOAQUIN LOCAL HEALTH DISTRICT res 21677 Rev, 7176 3M i <br />