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FOR OFFICE USE: � FOR OFFICE USE; <br /> APPLICATIQN FOR SANITATION PERMIT <br /> ------------------------ �'� - q <br /> -- ------------- - Per No._7!__-�-3-7 <br /> ----------- <br /> [Complete in Triplicate} ..___ <br /> -------------------- Date <br /> Q <br /> -- Date Issued._�_"!..__;�_ __ <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 �rv�.IL � _ -------- ---------CENSUS TRACT---------------------- ----' <br /> Owner's Name----- ?. ._}_:-- _�d4 ------------------ - ------I--------------- --------------------------Phone_ W_''' o_ <br /> Address g .( tc ihPr7� .�' ------ �---?---City- --`0 ---------------- -Zip-- ----- ---- <br /> Contractor's Name__ ------------------------- <br /> A,k,161--( --- - -- I �-�Q-=License # '�� -Phone_c7_5:T.-_. <br /> -iT <br /> Installation will serve; Residence: A art ent Hoyuse.❑ Commercial ❑ Trailer Court ❑ 1 <br /> r ` 1 <br /> .._ •: .. , .: Motel --`=----�, ,. <br /> j ------------------------- ----- <br /> Number of living units:__2------- Number of bedrooms___ ._`_Garbage Grinder-- '_______Lot Size__J--- �'�...,. <br /> Water Supply: Public System and name =_________________________ - `' ______Private' <br /> ' ----- = -------- - - -------- ---- <br /> Character of soil to a depth of 3 feet.- 'S nd.[]. -LSilt Ell"!-.Cloy ❑ —'Peat ❑' Sandy Loam . "Clay Loam ❑ <br /> Hardpan Adobe ❑ Fill Material__._.___.._If yes,type-------------------------------- <br /> 5 <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 /> { .1. <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ } f Size_____ ® /�- -.- Ir <br /> -1- _� 1�lquid Depfih.>_________________________v�� <br /> -Ca acit � �___._T �� �..Material_ �'___-- oo�partments__;__ ',4>j __-�..__-.__ 1 <br /> -Capacity YPe <br /> _ Distance:to nearest: Well__�� __-_-___— Foundation_-_ _ __ _ _- Prop. Line_.__ __.____.__-. <br /> -- <br /> LEACHING LINE; [ ,} No, of Lines.:_s ___ ______._ .'Length of ach [ine.__H ________________Total Length ____ ®__- +_-________ <br /> t <br /> t D' Box_.: ___ -Type Filter Material�__I. epth`Fdlter Material--`-- -- -- --------- = -----=------------------- - - <br /> f. �_ - . --- _ /. _-- o <br /> Distance;to nearest. Well:__ ___�- ___Foundation . .--_°__..------Property Line--- tom.__________. O� <br /> 9IPEYIT [ ] Depth. Diameter_. -__lif_;,___N'umber___:._. _ Rock Filled Yes No <br /> off- -- <br /> SWater Table Depth - ='- ------------------ �__�.Rock Size------ --- -------------------------------- t <br /> y Distance to'nearest:`Well_..____LO -- _.1`-._.Foundation:__c5.._-------.__'_.Prop. Line.,[-____.__.____.__ <br /> REPAIR/ADDITION•(Prev. Sanitation <br /> ! % Requirements) <br /> I; t <br /> g"Permit. #_-----------------=--=-- -------------=---=------iDate- i._-_______.____._____.__ ---- <br /> SePtic Tank (Specify Re uirements)---- ------ --------------------------------------------------"-- ------------=----------------- ----------} <br /> ---------------- ------------i- <br /> --- <br /> Disposal Field (Specify Requirements): .-: ------------------ ----------- `----- . ----------------------- ----------------------------- ------ <br /> -------------- <br /> ----- <br /> a -`--- � � � <br /> a <br /> l a <br /> ' - <br /> _ ------ <br /> S <br /> 4 ,.� t= (Draw existing cind'required addition-on reverse side) <br /> I hereby certify that.1 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 f <br /> signature certifies the following: Y <br /> .'I certify that in the performance of'the work for which this permit is issued; 1 shall not employ any person in such manner pis F <br /> to become_-sub' t. to_ i�flgrkm s .Com ation ws.of California." <br /> 1 �, <br /> Signed---- ----�-c ------------------ -- - --- ---------- ---�� t------Owner. <br /> : , 1 <br /> BY., ---- ------ ------ ;.. _Title1 <br /> a ] <br /> (If other thon�'owner) ` l <br /> .. 1. pDEPARTMENT U E ONLY f <br /> ---------- --- -----=- --- -`-------- -----DATE - y <br /> APPLICATION ACCEPTED BY----- III--- - --------- --- -°---------- .-- �-�- --��-��- -, -- <br /> DIVISION OF LAND NUMBER---- ---------` - -----------------------.DATE- -----.- ----------------------- <br /> ------------------------ <br /> t. <br /> ADDITIONALCOMMENTS:-------------------------------------:---------'.---------- -------------------- ------------------ --------------------------- <br /> --------------- <br /> ------------ - <br /> 1 ---- <br /> ---------- --------------------------------------------------------;-------------------- ------ <br /> - ------------------------------------ ---------- ---- ------ --------- W _._ . + <br /> ________________________________________ ---------------_ ------------------------------------------.___________ ------ <br /> ---------- <br /> EK <br /> __ _ <br /> Final Inspection b =^ - _..--.�_. = Dat . .•' <br /> - e- - - <br /> EK 13 24 SAN JOAQUIN OCAL HEALTH DISTRICT F&s 21677 REV. Z176 3M <br />