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ai` FOR OFFICE USE: <br /> �R OFFICE USE: "� <br /> APPLICATION FOR SANITATION PERMIT 2 <br /> r � <br /> ------------- ------------ • ----- ICamplete in Triplicate] Permit No..7 _"'3-7 <br /> i ----------- ' =' . <br /> ` J7 <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-con struct 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/LOCATION----J`-. ----- ----'=----'---- -----.CENSUS TRACT----------------- ----------- <br /> I one ; <br /> Owner's Name =C -- -------- -- " _ <br /> orf . z. <br /> Address = = E ------' rl City--------------------= :. Zip <br /> p ry Phone. f ------- <br /> Contractor s Name------- L/ G [► _License # /� T` � r <br /> Installation will,serve. i Residence ❑ Apartment House.❑ Commercial ❑ Trailer Court ❑ <br /> Other_ _+- r_-. 4-_ - <br /> I , <br /> YL -Motel' ❑ - Gyyr <br /> -• '"--rof bedrooms_ ,- ___Garbage rindex ' Lot Size_ ___ ----- -.... ---.----Number of living units _ Numbe <br /> ry <br /> Water Supply; Y Public.S stem and name------------------- - <br /> :------ --- ---------------- :------------------ --- --------- - -------------------------- Private <br /> Character of soil toad depth of 3 feet: Sand ❑ Silt❑ Clay ❑ . Peat ❑ Sandy Loam ❑ Clay Loam i <br /> � Hardpan ❑ Adobe ❑ Fill Material--------- -if yes, type-----------------'-------------- <br /> (Plot plan, showing slzetof lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (; <br /> NEW 'INSTALLATION: t[No;septic tarik"or seepage—pit-permitted if public sewer is available within 200 feet,] r r <br /> PACKAGE TREATMENT .[ ] SEPTIC TANK -[ ] Size--- .Tyy �j---- -- - -----T--------------Liquid Depth-- _...-----_-------tG <br /> t <br /> Ica acit __..Type- <br /> _-. _-Material_ No. Compartments.--'_--%�- ; _ <br /> __ ______, ____-- <br /> Distance to nearest: Well---/-- ----- _.Foundation.-. ? (� ._.. -.___.Prop. Line �____ . <br /> -- <br /> LEACHING LINE [']. ,No..of Lines.......... --.-.Length of eachlina _. _ --------------Total Lengthy y 710-"-----__ <br /> ['D' Box_. , _-.._Type Filter Material---- _ _ ._ DeptFi Filter Material ------------------------------------t <br /> Foundation_ �J_ _____;_ Pro er Line._,___;.5 ------.-._ <br /> ' iDista a to nearest: Well____ .- P tY <br /> eter._ .. . . <br /> yy oo�� <br /> T [ ];' Depth__ _1Y_��1.1_E�1Fn Number___'_ ___________________ Rock Filled Yes No ❑ <br /> i. <br /> Water Table Depth--------- __ ---.Rock _ ---- - <br /> f s-- <br /> l Distance to nearest: Well-- - - -'.-- Foundation---/ _ --.Prop. Line--------._._________________ <br /> REPAIR/ADDITION [Prev Sanitation Permit#--=----. ------=------- -'== "=- Date`__-°------`=-'------------------------ -) <br /> Septic Tank (Specify Requirements)--------- --------- ----------------= = ---=-------- <br /> Disposal Field (Specify Requ,irements]�'_ '-------------- --------------------------------------------------- <br /> i -------------------------------------- <br /> i i --------------------- - ------- --- --------- <br /> ----- - <br /> ------------------------------------------------ ------- <br /> n: ' <br /> { ---------------------------------------. .--.___._---...---."--_-._----.__----..---._-__-_-•_----------------_---------`--__ _.•�___ - .___________._.--.--_-- _�-----------___--_-"----------------- <br /> 1 " (Draw existing and required addition on reverse side) <br /> o I hereby certify that.1 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: <br /> F .ie : <br /> "I certify that in the performance of the work for which this permit is issued, I shall nut employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> i- Signed---- t -------- Owner ; <br /> i <br /> BY-I �--- -- �� Gt<.f(r"' _ Tit[e.---- -- - -- -------------- --- _ ---:.- <br /> r° ] <br /> (If other than owner) ` "+ <br /> ! FOR DEPARTMENT USE ONLY' <br /> 417 <br /> APPLICATION ACCEPTED l3 _-. :- ------ --- <br /> DATE :SRS �- <br /> DIVISION OF LAND NUMBER-------=------------- - ---=------7-1 .................. '--------------- ----------- ------------DATE----------------------- ----------------------- <br /> i <br /> ADDITIONALCOMMENTS--=--------------------------- ---- -------------------------------=------ --------------- ------------------------------ ----------- ----------- ------- ------ <br /> t .- -- ----------- ----------- ----------- <br /> --------------------- <br /> -'----;- ------------- - ---- -- -------- ---------------- <br /> 4 ----------------- <br /> -------------------------- <br /> -- <br /> --------------- <br /> ----- - 1" <br /> Final •Inspection bY--------;:� �.. _- .. _ _., -Date " <br /> z <br /> i EH 13 24 ` SAN JOAQUIN CAL HEALTH DISTRICT F&s�igzr�ev. 717ti 3M­ <br /> EH <br />