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_ FOR OFFICE USE: � FOR OFFICE USE: <br /> ----- ---------------------------- --- -- ---- APPLICATION FOR SANITATION PERI�Iy ) / <br /> (Complete in Tri I' ate) �_{`/ /� / Permit a.--:7. <br /> ---------------------- --------------------------- --- �•- �7 /� 7 7 <br /> sued___-- `-_'.. .7 <br /> _ <br /> --- ---_.._....__... This Permit Expires 1 Yea Fro <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct ar( s all the work herein described. <br /> ,This application is made in compliance with County Ordinance No. x549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION---' 8� _ .L/1 / .` ? E �JACI=_,10.41 .---------------------CENSUS TRACT--------------.-....---- - -- <br /> e.5t r <br /> Owner's Name---- N--�-----},-py-�,s�-� 0- - - --- --------- -----------------P ne---- <br /> Address - -------------- q�+� �-- -_. ._ - - C' P <br /> ---------- <br /> ---------------- ----- ---- ------- <br /> ----------------------------- <br /> 1�r tyr- - <br /> - - - - .cam �7 �r(7 <br /> Contractor's Name.._ _ .------ �--_-_._.__..._.____..License #._.5, _2ql- hone_____Jj���`�v�.( <br /> "Installation will serve: ResidenceApartment House F] Commercial E] Trailer Court E]Fotel ❑ Other-------------------------------------------- <br /> Number of living units:._.._-�.._-_.Number of bedrooms----3-_..Garbage Grinder------/._Lot Size___.._..___.._.___. ---.------------------------------ <br /> Water <br /> .._....__....._------_--GWater Supply: Public System and name- ----------------------------------------------------------------------------------------..................................Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 25 <br /> Fill Material------------ yes,type. A <br /> (Plot plan, showing size of lot, location o s'ystemIin relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep�ge pit permitted if public sewer is available within 200 feet,) <br /> `PACKAGE TREATMENT ( ] "—SE6C TANK ( ' ---Size--- _: <br /> �. =: -------- :_ _-.Q --t _ _ i----- <br /> Liquid Depth._4 <br /> r------------ <br /> Capacity--t200 <br /> _..__:-Capacity--t20y e_-_.___.-_..__.____Material-aoj _-_No. Compartments---------Z.----------- <br /> DistanceWell -s_- <br /> to nearest: Well__...IL�LE2_ ___._..._________...._foundation___._.l_Q_.;______._.Prop. Line___.SL}_.__._... _.__ <br /> LEACHING LINE [ ] No. of Lines------------cQ.______Length of each line------$_O-.-._._...------Total Length._.._._i...... ------- <br /> 'D' Box_%�5._--Type Filter Material.5_4/2929i6_..Depth Filter Material.......LIA.'­_.------_--..____._._-____..__._.___. <br /> Distance to nearest: Well-----1 ------------Foundation_-----z __..........Property Line.�------------------------------- <br /> SEEPAGE <br /> __. . _ _.____._.___-- <br /> SEEPAGE PIT [ ] Depth---9§......Diameter------33__._._Number___...____."2—_____._.. Rock Filled- Yes j4- No <br /> r <br /> ` Water Table Depth-------—-------10-0------------------------- <br /> ---_..Rock Size........... -------------------'------------- <br /> I <br /> i Distance to nearest: Well-------___ ':_.---.----f6unda?ion_----1.40---.__.....Prop. Pne.._S9U- ............... <br /> REPAIR/ADDITION-(BiV Sanitation Permit#--------; <br /> Date_.._ <br /> Septic Tank(Specify Rgquiremerits)-,-:--- ----`--:------------------------- ---_'-=-'------------------------.....-... <br /> Disposal'Field'(Specify Requirements)---------------------- ------------------------------------- --------------------------------------------------------------------------------- <br /> ----------------- ------ -e <br /> : - <br /> --------------------------- ----------------------- ---------------------- - ------------------------------------------------------------- - <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 /> { <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 0CuwG <br /> BY--------- - - . - - ----- _ - ---_..._ , Title--�- h �'` <br /> Ilf other an owner) <br /> FOR DEPARTMENT USE ONL <br /> APPLICATION ACCEPTED BY--- ------------------- -_ - - -----------DATE l2-7.-T7 — ---- <br /> DIVISION OF LAND NUMBER. - - - - - ... ......I------------- - -------------------DATE-------- ..... - ------- <br /> ADDITIONALCOMMENTS----------- ------------------------------- ---------------------------------------------------------------------------------------- ------------ ---------------- <br /> --------------- --------------------------------------------------------------------------' <br /> -----------------------------------------..........----------...._..-----------------------------------.. ------- . .......... <br /> .---- <br /> FinalInspection by;.-----._.- ----------------I--------------- -------------------------------------------------------_--------------Date <br /> r EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F65 21677 REV.7/76 3M <br />