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FUR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. S_ <br /> ------------ <br /> --------•-----•- ---•-- ... ..----- <br /> Date Issued..c�.1­gr 7 J_ <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 compliances with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION...... ........4.._$./-.2....-s- V4 , . llC 1 _ . �`'��' f <br /> Q -------- -------.CENSUS TRACT....-- - .. <br /> Owner's Name.... ... ......... 1d-�.. 4C_1�`l...S. Phone.__8.3 7 `> 7 e1 <br /> �y / -- ----- <br /> Address.- �._-l. ,�uC 0- 6N! -- City_ �l k V'! - ��•-----... .Zi <br /> n J Y-- .. . P <br /> Contractor's Name.-....- `�?r'J.ii?. e_G-1"eL .-....- - License #-....� -Q 77. ...Phone-. � <br /> Installation will serve: Residence ❑ Apartment House ❑ Co mercial ❑ Trailer Court ❑ }���`f 5 <br /> Motel ❑ Other-...� ?Grincler <br /> .. �nNumber of living units-----------------Number of bedrooms.--.........Gari ---.--------Lot Size----- ---------- <br /> .-WatWater <br /> er Supply: Public System and name-- .................. ....- -.---.......--Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt Q Clay ❑ Peat ❑ Sandy Loam']- Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ 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 /> PACKAGE TREATMENT ( ) SEPTIC TANK Y -Size . .-- X-- _X7 4--------------------- -------Liquid Depth..-- .�.M............. <br /> Capacity_.. `tN TYPefd.hrc.... .,... MaterNo. Compartments............2y----------- <br /> Distance to nearest: Well...-.......> �- - - ---- ---------Foundation...--- Prop. Line-._.f --.-----.--- � <br /> No. of Lines <br /> LEACHING LINE <br /> ,PQ` .... ......../ -..------.Length of each line.------ --- Total Length <br /> 'D' Box..../_ ...Type Filter Material ?-P�Depth Filter Material.- /8 sr <br /> Distance to nearest: Well--------•---------..........Foundation----------------------------Property Line---------.--- --- <br /> SEEPAGE PIT { ) Depth.. ....... .....Diameter------------____----Number..------------------------------ Rock Filled Yes ❑ No❑0%k Water Table Depth-- ---•------------------- -- - ------------.Rock Size...--.. ------------------------- <br /> Distance to nearest: Well----------4---------.........--------------Foundation................ -. Prop. Line........................... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#...................... - ---------------Date............._.___ <br /> Septic Tank (Specify Requirements)------ -- ------ - <br /> Disposal Field (Specify Requirements) ------------ --- <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 <br /> to become subject to Workman's Compensation laws of California." <br /> Signed ... .. . ..... .. Owner <br /> B Title.- v <br /> (if other than owner) <br /> OR DEPARTMENT USE ONLY qc� <br /> APPLICATION ACCEPTED BY-•---- -- DATE !.. - -- _..... <br /> - - ----------- <br /> DIVISION OF LAND NUMBER. ti -- - _ ............ ................ .. ...DATE. .. ...... <br /> ADDITIONAI,COMMENTS.... lliiuc� <br /> - J... <br /> .. ... ...- ..... � 11 � ------------- <br /> Wei r - ratan Pew." <br /> . w��r - <br /> T .. <br /> Final Inspection bY:.......... .Tr. - -------- Date-------- ---- -- --- <br /> e>i 's 24 F&S 21677 REV. 7/76 3M <br /> 4.�c�' SAN JOAQUIN LOCAL HEALTH DISTRICT <br />