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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .......................... ........... . ............... <br /> (Complete in Triplicate) Permit No..7...� a- <br /> ---------- -----------•------- <br /> i Date........................ This Permit Expires' I Year From Date Issued <br /> f <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 ADD u'„:., ; . ; r-- s <br /> RESS/.LOCA-TION:..... 3...... Q... rJv 19Pi� -j. CENSUS TRACT._..... <br /> ¢_ f Phone...?-.._ �`! VS......... <br /> Owner's Name rwo --- ---- ----- !. <br /> Cit S��....----•-..- .Z� <br /> Address - �---�F}++R.�---t�---- o-rd�.......- - - -- ---.�......... .......... Y-------- ---..........- p----- : ....- ------------ -- <br /> Contractor's <br /> Contractor's Name- ?.'.r_. ._.License # ------------­- -------- <br /> Installation will serve; Residence )( Apartment Hawse ❑ Commercial ❑ Trailer.Court ❑ <br /> J Motel ❑ OtherA'.. ............................. <br /> Number of living units::.......1._-----Number of drooms._3__ _ G` arbage Grinder_--------lot Size--_ � <br /> . ..-. I <br /> 44 <br /> Water Supply: Public System and name. _..... u - I................... - --- ---- -- ------._-Private ❑ I <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hard an Adobe Fill Mater <br /> P ❑ ❑ ial-. . If yes, type.. • ----------•-------------- - <br /> ,Ip <br />_(Plot plan-showing size of.lot, location,of.system in relation t�o wells, buildings, etc, mu.stTbe_plq d ckneverse side.) <br /> NEW INSTALLATION: (No septic tank or€,seepage pit permitted if-public sewer is available withiDe <br /> 200feet ) <br /> PACKAGE TREATMENT [ J SEPTIC TANK [ j Size ---- - --..,-,Liquid4 Pth -........... <br /> Capacity-- - --- -- Type--------------- : Materiaf- ------------------------No. Compartments''----------...- <br /> �....Foundation...-_...._ i <br /> ., Distance to nearest: Well--------------------�---. . � --------- -....-�----- <br /> € <br /> LEACHING LINE I -• - Total ngth .. . � ...---- i <br /> No, of Lines :..... .. . ......... . 1 <br /> D Box........_.,...Type Filter Material_th.of each liDeepth Filter Material_.._' \: __.... h--=-- --------- --------------- <br /> "41 <br /> it <br /> Distance to nearest: Well------------------ ��--.--...Foundation------------------.----.....Pro erty L?rl ------ ....---_----------------- <br /> ' <br /> --.---------- i <br /> - €p m , <br /> SEEPAGE PIT [ ] Depth- Diameter....................Number_-- ------ Yes ❑ No <br /> ---.Rock Size-- ------. �\ ` <br /> Water Table Depth.--��-----------•-•--------.;f�-� --�-------- •- ---- ----------- - ------ <br /> Distance to nearest: Well.-..----- ...... . ........ .Foundation._... ____....... -. -- Prop. Line._ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------- -------------_Date---....... - --------- ----- <br /> Septic Tank (Specify Requirements) ---- --- -------------- -- ----- --------------- ------------- l <br /> Disposal Field (Specify Requirements) -- ! dCi. Qly��Vki <br /> �; R � <br /> (Draw existing and requirereverse side) <br /> ! hereby tertiFy tha# I have prepared this application and that th6e 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 i <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this per t-is issue shall not employ any person in such manner as <br /> to beco a subj t to W rkman' Compensa ion laws of Cafifo�ia �t <br /> Signed.. - Owner <br /> BY------- .................... [ ........Title ------ ------------_------._..-------.......... -------- •-- - --- <br /> (if other than caner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- �; --- - -. .._.._ ------_DATE ..... '3 _ � ------------ ---------- <br /> .....- - - ---------------------- <br /> DIVISION OF LAND NUMBER.:- . --...... . ----------------DATE.--- ................ <br /> ADDITIONALCOMMENTS........ . ....... - ------- ............. ------. --.....-- --------------------- ---------------- ---------._...---------I_ ----- <br /> ------------------- <br /> ................... ...... ....... .... ........ ...... ------- ........ ----------- <br /> ----• ----- ----------------------------- <br /> I� - --------..�r <br /> Final Inspecxion b -:. Il ------------------------------- ------- --Date....!- �- 1677 RE ..._ .... . <br /> € FSS 21677 REV. 7176 3M <br /> EH 13 24 SAN JOAQUIN��LOCAL HEALTH DISTRICT <br />