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FOR OFFiICE USE. APPLICATION FOR SANITATION PERMIT <br /> Permit No: . ... .�--. .:. ...- <br /> �h %lr ....... (Complete in Triplicate) <br />........... I <br /> Date Issued `7`•- <br /> I This Permit Expires I Year From Date Issue <br /> 4........................... <br /> ruct and <br /> l the work <br /> rein <br /> to const <br /> A licat�on is hereby made to the San Joaquin local Health District narice Na'.544 and existing Rulestalnd Regulations: <br /> pp his application is made in compliance with County ._ <br /> r .........CENSUS TRACT .......................•.. <br /> described. <br /> ........... ..... <br /> JOB SS/LOCATION ........ --. •• _ Phone ._. -•. -....•- <br /> Owrier s Name U...K—e. .......................:.. G y —. . .. ...................... <br /> Addre `s _ : .r, -.fir-:..............J�•-- �c��i ...:.. Phone .d�'r�D . <br /> --•- <br /> Contractors ff Q Le1_. - _.L•++cense # . <br /> ''[Name -l:ct.�_ { ... 1 4 <br /> Installation,will serve: Residence Apartment House Commercial QTrailer Court 0Motel []Other- - ••----... <br /> Number of,living units:-..--1.-.... Number of bedrooms .... --Garbage Grinder ............ Lot Size ._ <br />'I .� <br /> I Peat- . Sandy Loam 0 Clay Loam;Q <br /> Water Supply: Public System-and name ..._-___ ---------- -------------------- <br /> Character of soil to a depth of 3 feet: Sand ID ill'-0—Clay'[Q • ❑ <br /> a - e . <br /> f Hardpan'Q Adobe C] Fill Material _.........._ I yes,typ - <br /> 1btc,rriust'be placed on reverse side.[ <br /> (Plot plan, shovOng size of lot, loco ian-of-system in relation to wells, buildings, <br /> "it permitted if public sewer is ovailaoe within 200 feet,) <br /> NEW INSTALLATION: (No,'septic tank or seepage p' p � _� Ilk <br /> Siae.......... � rs�..__/'..0------- Liquid Depth .-... . .. <br /> PACKAGE TREATMENT ( ] SEPTIC TANK. kr 6� <br /> V r}�t E No. Compartments ...�c"- ••, 1 <br /> Capacity ./ ��oA&L Type• ._ _ ------•._ Material : <br /> a d <br /> I J Foundation ..-._ <br /> 1-�1_-------- Prop. Line .. ..._......... <br /> Distance to nearest: Well �� F <br /> Total Length <br /> ' Leng h of ea line..--..-.� _....--- ---- •- ...... --... <br /> LEACHING LINE [ ) No.� of lines ..-----••�-••-.._ -_.. <br /> i I --•------- - - <br /> .D.,Box .-._ Type Fil#� �lUlie If._.. <br /> _Depth Filter <br /> - foundation ~��-•••••-•---~ Property Line <br /> .....--•--•-- <br /> E Distance to neo t-0Well.. �W ` No ❑ <br /> t •� Rock Filled Yes-❑ <br /> Z., <br /> Diameter ............................ <br /> Depth - ti ....!.-.... <br /> Number <br /> SEEPAGE IT [ ) p <br /> Water Table Depth -----•--•--- <br /> ...................Rock Size ......................... -•---- <br /> ....Foundation --. Prop. Line ----•------•---•---•-- <br /> Distance to nearest: Well :__.]•..•••... a <br /> l <br /> .......... t _... Date ---•--...... <br /> ------- <br /> ,REPAIR/ADDITION(Prev. Sanitation Permit# ! .................. <br /> . .,�: a <br /> < Septic Tank '(Specify Requirements) .._" 4 i <br /> Disposal Field {specify Requirements) I ... <br /> ......----°-------- -•--•....................•-----........ -- <br /> ` _.. <br /> b -----......... ••-•-••--•- <br /> ---••- ............. . I <br /> ...---------- <br /> -----•.................•--•---••-•..... <br /> -----------• = . <br /> i '•-----'-"-• i (Draw existing and required addition on reverse side) ' <br /> 1 hereby certify4hat I have prepared this application and that the work will be done!in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regu)ations of the_,San Joaquin Local Health District. Home owner or licen <br /> sed agents Signa ure certifies the following:. '• #t arson in such manner <br /> "I certify'i that in the performance of the work for which this permit is issued, I shall not employ any P <br /> as to become subiect to Workman's Compensation laws of California." <br /> ------ Owner <br /> Signed { .................. <br /> g I •--------••--•---•--•----•-•-. .. a ... .......... <br /> ' C. --------------•-_.. 3 ----- r ------ <br /> Title ".. 1 <br /> (If other than owner) , <br /> " FOR DEPARTMENT USE ONLY <br /> _ ' DATE y <br /> APPLICATION ACCEPTED BY ---- ---------•_.-... <br /> .. •-------------------••--•._-.....---....----...,. DATE .-...........---..._ -••----• <br /> BUILDING PERMIT ISSUED .........:.................... .....i-- _.:..: <br /> ADDITIONAL COMMENTS ------•----- -----• ------••---•...... --------- �ti• .j <br /> .....••. --- <br /> . ........ Date / <br /> ..... <br /> Final Inspection by: ..---- <br /> c SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/723 ,1 <br />