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4 FOR OFFICE USE; FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT —79?- <br /> ------------------------------------------ --------- Permit No lS- <br /> - [Complete in Triplicate] -------- <br /> ---- ---------------------------------------- /_ <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: i <br /> JOB ADDRESS/LOCATION '�"­--.- V'�S's�N�GY.� `-- ------ <br /> `..-- - -------.CENSUS TRACT.... ----- ------ <br /> .� s <br /> Owner's Name. �� M�,,N. -----O r --- --------------------------LT � �r� � . one <br /> �ws'M�. ' 'Ci Y ----- Zip -- ---- <br /> ---- - - -` z <br /> Address--- — _ <br /> Contractor'"s Name_._.Se�7 -- -- - - -- ----License #---- ----- Phone --: -- ------ <br /> Installation! will serve: _ Residence's Apar ment. House ❑ ­Commerolpl ❑ Trailer Court ❑ } <br /> Number oftliving units-_. ____.___Number,of bedrooms_:_ arbage Grinder.__._ Lot Size_ - .1 ------- <br /> Number -- <br /> MtaR�c , kN\,;Nn•v --------------- ----------- <br /> Water --------- --------------------- Private ❑ <br /> Water Supply: Public System and name =-:. .•-----`-- --- -- <br /> Character cf soil to a depth of�3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Loom"❑ Clay Loam ❑ i <br /> Hardpan ❑ Adobe'X Fill Material---------------If yes,type------ ------------------- --- k <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 r <br /> [ ] Sizeq pSEPTIC'TANK-"PACKAGE TREATMENT <br /> # ----- -- <br /> �\,,',q. Capacity- --- - TYpe === ._ Material -'"------------ - ---No. Compartments. �. <br /> •� Distancejo nearest.:.Well---------------'--- ------- -- Foundation-------------- - --------Prop. Line - = <br /> f each _ <br /> LEACHING LINE- j;] No. of Lines. -_;_,__ -__. Lengtha . h,line.__ ___.= `-- '.____.Total Length ,_ -----------'_____.__ __. <br /> 'D' Box Type Filter Mate'rial _ depth�Filte Material_ <br /> --- <br /> ! at I <br /> e Distanceto nearest: Well----------------------'---- Foundation_.___._---------'----------Property Line--------------------------- =-------- <br /> SEEPAGE PIT [ ] Depth------........ .Diameter------------..----------Number.-- ------:-------------:-----=- Rock Filled �Yes ❑ No❑ <br /> r .. Rock Size.---- --- - --------- ---- <br /> Water Table b-ept ----- ------- ------------------------- <br /> ----------------------- <br /> Distance <br /> - ----- - --- <br /> r --------------- <br /> I <br /> f Distance to-nearest: Well.-'-.- --°-------------------=-------------Foundation--:------ ----------.Prop. Line <br /> --___-- <br /> -.Da t-- . ::--------- <br /> EPAIR/ADDITION (Pre y,:Sanitation Permit#-----_�-=------------------------�--- ':----- to - -j <br /> . t- -sti,;- ------- <br /> Septic TankI(Specify Requirements]-- =! �`= = = = = = - ----------- ----- <br /> 1 <br /> sposal Field (Specify Requirements)—/ -QD_---- VQ Ctse,�� "w ----------------------- <br /> Di <br /> ----- '- (-- ----- - a <br /> - ---------- ------------ <br /> ------ ------------ -- . <br /> # (Draw existingng clnd'required addifion on reverse sside] <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances,1 State Laws, and Rules .and Regulations of the San Joaquin Local Health District. Home owner or licensed.agents <br /> signature certifies tate following: .7_ <br /> F I <br /> "I this permit is issued, I sh'i:II riot employ any person in such manner as <br /> certify that in the performance of"We Work for which <br /> to beco a ubje�t to or an's Gompens aws of California.. .. <br /> Signed ----- ----- - y <br /> Owner I ) <br /> BY----------------------------- ------------- - 1t <br /> T le <br /> (If other than owner) '` <br /> FOR DEPARTMENT USE ONLY <br /> ; - ------------------ <br /> APPLICATION '---DATE ----------------'� ------------------ <br /> ACCEPTED BY------- -- -------------------------- ------------ <br /> ---- <br /> -- - --- <br /> DIVISIO_N-OF LAND NUMBER!------- '.' --<_�.__ - -_----------- . i- --- ----------- - DATE------------------- <br /> F..,� - ... <br /> -- - <br /> ADDITIONAL COMMENTS------------------ `----------------------------------- <br /> _�. .. . <br /> i -------------- <br /> 1 i ------------------------- - --=----=---- - <br /> [ .L • ______________--------_____________________________ <br /> ----------------------------------------------------------- ry-------------------------- �..-- __--_'� -4-----------�------- --------- - - - ----.----------------- <br /> ---------------------- - - - - - - - - _. <br /> Final.Ins Inspection b 7------ -"`"""`------ ' ---µ " .� -.-__ Date_:�`-.�------------------------------- <br /> -----------p Y _" _---------- - <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ,- �j 9&5 21677 REV. 7/76 3M <br /> 5, <br />