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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 76'- �j <br /> F (Complete in Triplicate) Permit No..._..._--:.'. . -._ -. <br /> ---••--------------------------------------------- Date Issued... z-..78 <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 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/LOCATION <br /> W d" CENSUS TRACT.. a J....... <br /> Owner's Name _..._.... ... � Pwl---- .. -ti-� - .' .Phone...:.._.. <br /> Address 7ff��.._ ./�....C�h_.�, � ..........�--- .-- Cit -Z.V -11`r-C . Zi <br /> Y . . .--.. -- P--f_.5--- <br /> Contractor's Name- � ,..... ! trTit.P.f. •.. ............... ------License # �Z ��� Phone J <br /> Installation will serve; Residence P�' Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other......... , <br /> Number of living units;......!✓---------Number of bedrooms....._. Garbage Grinder:.. _....Lot Size.-....-..._ �'?�S:-_...:....__.... .-. <br /> [ . . .. <br /> PP Y Y le....._ ------------------ a ....... ------- -------Private <br /> ater u PublicSystem stem and nam <br /> Character of soil to a depth of 3 feet: Sand Pjj� Silt❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam [] Ik <br /> Hardpan ❑ Adobe ❑ Fill Material.. .... ....tf 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 /> I PACKAGE TREATMENT ( ] SEPTIC TANK 1 ;I <br /> Size. ----•--------------------•------------------Liquid Depth.--3-6--------------- <br /> Capacity-J.2-do Pl_TYPe ' -��-s-..-- --Materiol-(/49�f <br /> ..-....:Na. Compartments_.. 2 <br /> Distance to nearest: Well--..-- ........... .... .........Foundation- la— -------.- ...Prop. Line...-� <br /> / 4 <br /> LEACHING LINE [ ) Na of Lines -------��-----------------Length of each line....._ ...-..- -:-._---Total Leength v�ld.------._-....._- ------- <br /> 'D' <br /> ----- \, <br /> Distance near est: FWelr Material...1" G' Depth Filter Material-- .-....�7.��...__.;.... /^ �............... i. <br /> fly................ Foundation----------- Property Line------ <br /> SEEPAGE PIT [ ] Depth_.._ J.Diameter---------------- - - <br /> Number.... <br /> -- - -------------------------- Rock Filled Yes ❑ No I <br /> Water Table Depth....... •------ ------ ----.Rock Size--- ---- ------------------- <br /> -------------- - <br /> Distance to nearest: Well,-------------------................-------Foundation-.... _ -._.. ......Prop, Line----....... <br /> -...- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#..............::_-... ----------Date---.--------.-- <br /> Septic Tank [Specify Requirements ...... <br /> ` ......--•-- ..... ------- ----- ---- <br /> Disposal Field (Specify Requirements)... .....:...........: .. ----------------------- # <br /> ................................................... _ 3 <br /> fl <br /> ----------------------- <br /> ---- —'---- --i----- -- <br /> -- -� ------------------------•-••--------........... ----------- -- <br /> - '--................................... <br /> �'�` <br /> (Draw existing and required addition on reverse side) <br /> I 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 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 z <br /> to becom object o Warkma Compensation laws of California."Signed --.: -. ...Owner <br /> ����� . <br /> •..... .- -- ------------ ---- i' 0 <br /> BY...... ..-. Title ----------------------------- ---------------- -------------- .......... <br /> (If other than owner) <br /> FO DEPARTMENT USE ONLY " <br /> APPLICATION ACCEPTED BY-•-- !. - - -- ---------- <br /> DIVISION OF LAND NUMBER'..-_"", DATE.... <br /> ------ - ---- - -- ---------------- <br /> ADDITIONAL <br /> ---- ----- ----ADDITIONAL COMMENTS.....---------- _._; _--........................ <br /> ---------------- •-- ---------- -- <br /> ) <br /> ........................ ..................... . .. . --- ------------------- - -- ---- ------........-------------------------------... .------------ ---------- <br /> Final Inspection b ----------- -- ------------------------------ 1- ------ .......Date_... <br /> EH 13 44 SAN JOAQU N LOCAL HEALTH DISTRICT <br /> Fd5 21677 /76 3M <br />