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r <br /> J FOR OFFICE USE: FOR OFFICE 'USE:.::"..:. 1 <br /> g/"'APPLICATION FOR SANITATION PERMIT <br /> t <br /> ... . ------- <br /> I� (Complete in Triplicate} Permit <br /> --• •-- -- ------`------ <br /> r �I Date Issued._7.��2. ,�-7� <br /> _______________________ --___._.._.-_ This Permit Expires 1 Year From Date Issued <br /> ,F , <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: a <br /> JOB <br /> -------- -- ---------CENSUS TRACT....• <br /> ADDRESS/LOCATION-.--.....k-1-l--�i�-�-----........ -- - --- - --�=- ------------- <br /> wrier"' <br /> ---- --...---- - <br /> Owner"s Name,.... .- ......--- 'I 1./. ... 1> Phone !~ ..._: <br /> w <br /> Address I rsC'( Yj-------- l✓. . ...._._ - .._-6.... ---- ...City ---Zip -- <br /> Contractor's Name......- ri License # � 3g .Phone.-: s�._. <br /> I .... ..l. <br /> Installation ,will- serve: Residence ❑ Apartment House E] Commercial-[]—Trailer'' Court <br /> Num }� <br /> 4 -:-.Motel--�❑—�-Other-.-... -- ---`:- , <br /> ber g <br /> f.livin units: ._ . Number of bedrooms_.. .__ Garbage Grinder.__-. _-._.-Lot Size ._�'� <br /> 9 1 . g - <br /> Water Supp[Y:-Public System and name!. --•---------------------��- --...' -. Private ^ <br /> Choracter.,of soil to a depth of 31feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe DC Fill Material.. ._-. ....If yes', type---------------------- <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings, etcmust be placed on reverse side 1 <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT F Size <br /> [ . SEPTIC TANK [ ' _- Lsquid Depth �.i <br /> Capacity.....................Type--- --- -------- - .. Material---------------------------- Compartments"----------------------- ------------ <br /> } <br /> Distance <br /> to nearest: Well_:_-------- -- --------------- ---- -- Foundation..--_-. -- - ----.-.-- ._.Prop. Line + -" .._- <br /> l�' ----------------------------- <br /> -- - ----- -- -- �. <br /> ' LINE ( ] � Na. af�Lines � _ �. _ Length-!of each lino ..__-.-__._.:---- -----------Total Length .... ............... <br /> LEACHING, <br /> D Box,.... -.....Type Filter Material.._ ... _......Depth Filter�Material--.--: --- .................. <br /> - � <br /> Distance to nearest: Well__------•------- ..-....___ Foundation---------:-----------------Property Line- <br /> SEE;P,AGEPf IT Depth. Diameter..---------- - Number---------------- ------ - <br /> Rock <br /> oc <br /> Filled.- Yes <br /> Water Table Depth-------•-------•----------- ----------------------_------Rock Size._ . --- . ----------- - -❑ <br /> -. ------ <br /> _....Foundation.-._..._- Pro Line _ <br /> �" �• � : Distance to nearest: Well..........---- ------.-' - ......._ ...-.. ._ p .:----- <br /> REPAIR <br /> /ADDITION (Prev,[Prey. Sanitation Permit#------- -----•-- = D to ` - 1 <br /> Septic Tank (Specify Requirements .......:-.4---,.IG -----._ 41171 <br /> °�.--�� <br /> Disposal Field (Specify Requirements)- - °Z _. .�f _r X v�s5...,_.._. czs,n.`_. ..._. ; <br /> ____________________________"_______r- .-.. -___---______. _----_._ <br /> :. II . - --- ---- <br /> ----- ....... -- ----- --------------------------------------------------- ------ ......­---- <br /> (Draw existing and required addition on reverse side) "' 1 <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 I�Rules and Regulations of the San Joaquin Local Health Districts Home ownec.or luehsed agents. <br /> sig'nature.certifies the following: "4 <br /> 16 <br /> 1 certify. that in the performance of the-work-for--which this permit is issued, 1 shall not employ any personin such manner as r <br /> r <br /> to:become su to W rkm� Co ensatio laws of California.". � y <br /> Signed <br /> .-. Owner <br /> ---- ` ......--. ; <br /> 'cl <br /> (If others than owner) <br /> Iii € "FOJ DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----.)_... ------- --------- DATE <br /> i DfVISION OF LAND NUMBER-.ilk _ = .: :.. DATE <br /> -- -- <br /> ADDIT.1 AL COMMENTS- _ " ....:. ; - .4 wt <br /> ....:_l.".---- <br /> 9 "1r+ q <br /> .. T _ k _.. __. .__ - <br /> S s <br /> { l� - f <br /> _. .. _._ .... __ _-....___ <br /> Fina! Inspeciion by: --- _---- - - -- D t <br /> EH"i3 24 SAN JOAQUIN LOCAL HEAL IST.RICT Fes 2ra�� REV..7/76 3fr' <br />