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'FOR OFFICE USE: FOR OFFICE USE: <br /> 30 APPLICATION FOR SANITATION PERMIT <br /> . Pry -2/, <br /> (Complete in Triplicate) <br /> Permit No..,?J_. ......_._ <br /> ----------- <br /> Date Issued. <br /> ....- ..- <br /> •-••••-•-•................. ...................... This Permit Expires 1 Year From Date Issued <br /> I 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 oylia Se ith County Ordinance No.-549-and`existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.. -- ---------- ----# 1 .YYNO.I!1r ----473+. <br /> ... . ---- --------.._.CENSUS TRACT-----------'...........-........ <br /> Owner's Name.......N�,1a---�.. of 1..1 G.4A......T1r`kS.S <br /> Address T'.a` .C-..---- t—t �. - City -�...----------Zip---. • -• <br /> Contractor's Name..{ 1r1��+'.1.. License #.. .` ��.Phone......... <br /> Installation will serve: Residence ❑_ Apartment House ❑ Comrriercial ] Trailer Court ❑ , <br /> hD <br /> Nu Motel ❑ OtWO.. ...:'.... ------------- <br /> tuber of living units: ...............Number of bedrooms', -------Garbage <br /> } <br /> t Water Supply: Public System and name.......................'---------:........................... -•------------------------------- .-- ---.----.-------_;........Private ❑ <br /> . . � t , <br /> Character of soil to a depth of 3 feet: Sand ❑,y ' SiIt;❑ Clay [D Peat E] Sandy Loam E] Clay Loam E] . <br /> Hardpan [❑ Adobe V • Fill 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ <br /> " <br /> PACKAGE TREATMENT SEPTIC TANK KI Size.-... _..-J�.�g�..................Liquid Depth... -f....--..--.._-.-- <br /> -,.�,Capacityj_ ..<D-._-Type-.01� .......Material. .R_....:No• Compartments....? ------ .. <br /> -- ---- - - -- <br /> .a. .,. Distance to nearest: Well.:.-._15 ........ ............ Foundation..---.10._.----------Prop. Line..........-. -.-...-----.... <br /> LEACHING LINE ( ] No. of Lines - 1 1 <br /> I �..............Length of each line.-----=-E.a..D..--..--....Total Length .. ...tQ-Q--.-.----- --•----..� <br /> I . 7 <br /> 'D' Box.....1......Type Filter Material....................Depth'Filter Material--................................................----...... <br /> .. , <br /> -tDisrance,to nearest: Well............................Foundation-----.----------- Property Line............-...-. - .............. <br /> SEEPAGE PIT [ ] °.Depth-7--!571...._Diameter__73.�i1- ---Number..-....t....................... Rock Filled Yes� No <br /> ,'Water Table Depth--------------------------- - - --- ---------------------Rock Size...A/Y--...........................h 1_, 1 <br /> Distance to nearest: Well...�.rjQ .__' .._..-...._..._...Foundation---�d." ......._....Prop, Line....�G. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#----------------- '----------- ------- ----Date-------•--•-.-..-. ---- -..-..-......--...----} <br /> �. Septic Tank [Specify Requirements].-- ..... ----••------------- .. -- -----------------------. .-----------..........-- - -----=---------- -................... <br /> Disposal Field (Specify Requirements) i :77------------ : ..- --. '- --- ................::........................----...................... <br /> ------------------- ------------------ <br /> ------- ----------------•------•-----'------------------ --- - -------•.........--------- ------- <br /> i <br /> ---------------------'-----------...----------------------------------- <br /> ,(Dra existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that"the walk will: be doneiri accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules a'Td Regulations 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 which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed-- -...------ .......... ------------- -------- --- ---- •--------- ---- --- ...Owner <br /> I By....... ' <br /> Title....-...... - <br /> o er than owner[ <br /> E <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ - ----- - --- ------•------- DATE ...... --/. . ..... .�..�... <br /> DIVISION OF LAND NUMBER - . DAT - ------------- ...... <br /> i ........ <br /> ADDITIONAL COMMENTS_.. --........ -- . .. --- <br /> if_ok....J A 1b1� . . .------- <br /> --------------- <br /> - --------------------------- z� <br /> Final Inspe;&ion by:...................... APhV!1. .... . .... . .... --• - -...------------------------------------ -- -------------Date___ ..i t- ....[�//} ..... <br /> 1, EH f3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F� 2ia�i REd/. 7/7C 3M <br />