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FOR 0.FFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE <br /> ---------------------I........ ............. ... (Complete in Triplicate) Permit No.7.7.-1/A.7... <br /> ---------------- ........­-------- <br /> ..........­­------------ This Permit Expires ] Year From D Date Issued­��?---T7. <br /> atellssued <br /> Appl cation is hereby made to.'the San Joaquin Local Health District for a permit to I construct and install the work herein described. <br /> This bplolication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> J061 DDRESSAOCATION....0 <br /> .................. ..............­.................... .................. ----------------CENSUS TRACT------------ <br /> Owner's Name...... ............... ........Phone....­------­----------- -.--- <br /> Address.... <br /> .... <br /> ................. .... .. ...................... <br /> Address.......... <br /> - -------------------- --- .............. -- ----- ----------Zip--------- ------- ....... <br /> Contriactor s Name............. <br /> ................. <br /> 4 ....License 4.34-$19P.........Phone <br /> Insta,ilation will serve: Re.sidence)d Apartment House o Commercial E] Trailer Court E] <br /> Motel ❑ Other....... ­... ............. <br /> 7 <br /> ` <br /> Number of living units:.. -- <br /> - ----Number of bedrooms Garbage Grinder--- -----:..Lot Size./7,7....X--S ------- <br /> Watel Supply. P6bl ic System and name......­ <br /> ------------------------ ...... ........ -----.7-Private <br /> Character of soil'to a depth of 3 feet; Sand E] Silt E] Clay Ej Peat ❑ Sandy Loom Ej Clay Loam ❑ <br /> Hardpan V Adobe ❑ Fill Material . . . If yes, type....-.--••---------------------- <br /> i (Plot plan, <br /> ype.­..--­---------------------- <br /> (plotplan, showing size of lot, location of system in relation:to wells, buildings, etc. must be placed on reverse side.) <br /> NEWJINSTALLATION. (No 'Septic tank or seepage pit permitted,,if public sewer is available within 200 feet,) <br /> 4-" <br /> PACKAGE TREATMENT SEPTIC TANK Size- -------------------------------------Liquid Depth.�.......... ------------ <br /> Capac,ity..kW0.0----...Type-94U-e Material-C-01WICej..........No. Compartments........1?1 <br /> I. 57 ------------- <br /> Distance to nearest. Well--------. ---------Foundation...... Prop. Line......P ..... <br /> L <br /> LEACHING LINE' No. of Lines... . .........LLength of each line.... ... Total Length .................--- <br /> D' Box.--- T <br /> .­ � terial /Pp.-* Filter ------------------------­--­­­.......... <br /> ype Filter Ma01 - - Depth I Material. -1.49-" —0 <br /> Distance to nearL-st; Weii;-------`0.-n..:..._....:Foundation.... 6.... .......-.Property Line...-..... ------.._.._...__ ------- <br /> SEEPAGE PIT bC De Rock Filled 'Yeso No E, <br /> p ...Number.......47--------------------- <br /> ,Water Table Depth....-------J200----­ ­---------­---------Rock Size­TLg;?' ------­--------- -------- <br /> It - j.:40 <br /> Distance to nearest: Well.- -------------------Foundation—4' .4---..-.°..-Prop. Line­js�-------------- <br /> REPj /ADDITION (Prev.'Sanitd-fion Permit#."-_._-.._......'.......-. <br /> . ......------------ --------------------------- <br /> Septi'-'Tank (Specify Requirements)—........... --------------------------- <br /> i . <br /> ---------------- - ---- LL -- ................... <br /> -Disposal Field (Specify Requirenents)­- .. --------------------W------ --------------------------- ------ <br /> -- <br /> ------ <br /> -----------------------LL ---------­-----­--L...... ------- ------- ---------------------- ------------------------------------ .......... ------ -------*--------------------- ........... <br /> ........ ........ ------------L------ --- -- -----------------------------------------------L-----------------------------------------------I-------- <br /> (Draw existing and required addition on reverse side) <br /> I herl'by certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County <br /> Orclin'� <br /> ances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> .11 0 <br /> certify that in the performance of the work for which this permit !Srissued, I shall not employ any person in such manner as <br /> to be, oryie subie' to Workman Com ensation laws of California." <br /> I <br /> e <br /> -- - ---- -- -- ----------------- <br /> Sign <br /> L <br /> Owner <br /> By.... ------- ------ AAR---0- ------------------- Title- ----------- ---------- --------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By IAp P ai <br /> . . . DATE... - - <br /> .. ...... <br /> -D--I-V--I-S--I-O---N--L-O---F -- - NUMBER.. <br /> UN . rs----a------------- - - ..................DATE. ....---- ------- <br /> ADDITIONAL COMMENTS ------- ------------------ <br /> ► <br /> - -86 - - --- -- ..... ................... --- ---- <br /> - <br /> w4 <br /> :.... :.. <br /> ---------------- ----------- <br /> I <br /> - ------------­-------I---------- ........ <br /> ----------------I--------------------------------------- ------- -- <br /> Finalnspe6on by:..---.-----­----------- .... -----------------------------------------— - <br /> I[I ....... -------------------------------- --Date- ­ ........­-------------- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV, 717 <br />