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FOR OFFICE.USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicattb) Permit NoZg7�/ - <br /> ------------------ -------�--------- ------ ---- {';'),� Date Issued///w=-7r <br /> ^ This Permit Expires 1 Year From Dateissued <br /> j Application is hereby made to the San Joaquin Local Health District for a per m'rit 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 ADDRESS/,LOC TION. /S T <br /> /��� t <br /> - -------- - --------- -------------aCENSUS TRACT- ._. <br /> Owner's Name- 41 - . --- --- - - . -- - 9 F Phone J !� <br /> -------------------- <br /> Address_- `y ----. -- -- ' City Ciaf .Z' ��,, <br /> '< <br /> F <br /> Contractor's Name--'� _ ;,� ---- ---- <br /> ' '`~-:--- - - ---------------- -----L e -_ - --- - ne <br /> Installation willryserve: Residence gs Apartment House.❑ Commercial ❑ -Trailer Courrt <br /> . .. . .. , . ..._.. -.. ...Motel-�--0th.er�-- -- <br /> Number of living units:. ____Number of.6edrooms ___ ------Garbage Grinder----- .Lot ------------------------------- <br /> Water <br /> -_----.---,------------ ----Water Supply: Public System and name - ------------ _r -- - f� /-------------- <br /> Sand <br /> - -: - Private <br /> Character of soil to a depth of 3 feet: San d [� :Silt❑ Clay: '< Peat ❑ ,. an'dy L m,❑ Clay-Loam ❑._ <br /> - •..,. •_ : Adobe Fill Material_ If ye type--------- <br /> -� '% <br /> Hardpan ❑ ❑ - <br /> = aI Y <br /> (Plot plan, showing size of lot, location offsystem in relation to wells, buildings, etc/must`be placed on reverse side.) s <br /> NEW INSTALLATION: (No'septic tank orrsseepageppitt permitted-if ublic sewer is available within 200 feet) s <br /> PACKAGE TREATMENT /[—]- SEPTIC TANK .. '•a � X--J(�- <br /> }' Size: = - �f -=�� -----------Liquid Depth.--------------- ---------- <br /> Capacity�?' -�"`Type__ _t4_ ------:::Material Yf _ -_. -No. Compartments---------------- <br /> Distance to rYearest:We1:1 =,�-.r-._.,_.___= = `-------------`Foundation_,._ _ --------Prop. Line----/ -- <br /> g <br /> LEACHING LINE -- T - _. _ '.Length•of each / Length -.-.-/. f <br /> [e✓]f No. of Lines- -, fih®„ � I <br /> w �.: , . Total <br /> ' D' Box--/ Filteri -d"eenf _w_-_”-�i/_L_ Depth <br /> epth�Filter Material___-__ ___ - <br /> _ <br /> Distanceto n earest: Weli sr /+fid \ Foundation Property Line ._OR' <br /> SEEPAGE PIT Depth_ "_ _.__ ....Diameter i_�_____ _ Number ____ Rock Filled Yes �— Nof <br /> - <br /> Water Table'Depth- ,,� ----------- <br /> ---- <br /> ----- /-•----- <br /> - ----Rock Size_ �'-� ----- <br /> -------- ------ <br /> Distance to nearest; 1Nell_-'___ _----________------_------.Foundations_:-----------------------Pro <br /> REPAIR/ADDITION (Preva Sanitation Permit#________ ------------ -- R <br /> --- ------ --- -.Date- <br /> - ) <br /> Septic Tank.(Specify Requirements)---- ------------- ----- ------------- <br /> -------------------- ---------------------------------I----------------- --------- <br /> Disposal <br /> ; --- ---------- <br /> Disposal Field (Specify Requirements).__- <br /> ---- ------------------------------------------ <br /> ------------- = <br /> --- ----- ---- <br /> .(Draw existing and required addition-on reverse.side)., <br /> 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 Regulationq <br /> s of`the. San Joaquin Local Health District, Home owner or licensed agents ' <br /> signature certifies the following: <br /> "I certify that in the performance of the'work"for-whicli'this permit'is issued, :I shall not employ any person in -such' nianner'as <br /> to become subject to Wo an's C99ipensation- laws of California." <br /> Signed --- :�:�; ---: <br /> c..l� <br /> Y isle "4I, <br /> O <br /> caner <br /> (If other than owner} ` i : <br /> FOR"DEPARTMEN'T USE ONLY' <br /> # - <br /> APPLICATION ACCEPTED SY - _ -----_- .. =- DATE-, �_-- a <br /> DIVISION OF LAND NUMBER`------ -- --------.--:-----------------=- -- -- - ----.DATE <br /> ADDITIONAL COMMENTS----- -------------:------------ ---------- - - <br /> I ------------------------------- <br /> ------------- -------------------- ----------------- -------------------- <br /> ----------------- ----- - - ----- --------------------------- <br /> - --- - ---------- ----- <br /> --- - <br /> ---------------------------- <br /> - ------ ----- - --- --- - -- ------ <br /> Final Inspection by:--- ----d <br /> - <br /> EH 13 24 Datef <br /> SAN JOAQUIN <br /> LOCAL HEALTH DISTRICTF&s 27677 REV, 7/`76 3M <br />