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FOR OFFICE USE:FICE UM s <br /> APPLICATION FOR SANITATION PERMIT •b <br /> ........................... Permit No.7..24.. <br /> (Ctimple}e in Triplicate) <br /> Date lssued./�i5::27 <br /> --_•-- ........ This Permit Expires 7 Year From Date Issued <br /> ion is hereby made to the San Joaquin Local Health District for a permit to construct and,instali the work herein described. } <br /> 1 application is made in compliance with ty Ordinance No.549 and existing Rules and Regulations: <br /> JOBRADDRESS/LOCATION.--- -! _... _ L....�-•-• N _. <br /> CE SUS TRACT ---------....------ <br /> Owner's Nanme�.._. . --- ...-.. ----- . . . ........s ...•_ _--- Phone_. -pp -- ..... r . <br /> �y.n. /F1;t. . <br /> Address.... 2U.L1�. -----... ......�s..1. XIJ.�.... ........... iA'..�. .. . ...........--Z'p--T>S.a�.�.�'.2.Q:....,� <br /> Contractors Name..... .f----------------- ...0.......P......... :;......... .... License ............... Phone..._-..... ......._......,-:.. <br /> K Installation will serve: Residence Apartment House❑ Commercial❑ Trailer Ecort.;k <br /> Motel p Other------------------ ----•- <br /> Number of living units:.._..1_...._Number of bedroo s...._��.Garbage Grincier_....._.._Lot Size_"._" .. --- . <br /> i. -+' .Priva� <br /> Water Supply: Public System and name........ ..... ..•- - - - -. .:-••- .".'.-------••_-....,-�-•--------^--------_. -....._..----•---.......----- ❑ <br /> Character-of soil to a depth of 3 feet: Sand ❑ Silt❑ Cloy[] Peat 1-1Sandy loam Clay Loam.{�j <br /> ❑ <br /> l: Hardpan X Adobe❑ Fill Material..... ------If yes,type-------------- ------:-- <br /> i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, eic, must be placed on reverse side.} `7 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> _ <br /> _ <br /> _...... . <br /> Li th..y: ._......_i <br /> PACKAGE TREATMENT [ 1 SEPTIC TANK 41 Size-:----- --- - �-`f :_ quid Dep <br /> - -- " -- .Materi ..iY1._._...No.•Comportmenis. w <br /> Capacity/A- Type ........ ------ <br /> i <br /> �..a.. ......................Foundation._� --------- <br /> LE <br /> :�;..._..__.Prop. Line..S.i� ...... Q( <br /> _ Distance.to nearest: Well.... <br /> C <br /> LEACHING LINE );']- _ No. of Lines.....12_-----------.------Length of each line-:S -- -Tom) Length:`../ � --------- ------ <br /> A L q S.c - - <br /> y 'D' Box." ..._...Type Filter Material ..!r_.....Depth Filter material....I./..................... <br /> A <br /> r. <br /> 4 1Qgf,_I'f...._. _..Property Line..�. .......... ......- <br /> Distancetonearest:Well.Tl�O;:.......--.-Foundation♦. .. r ,•, ; <br /> ;I .. _ -. <br /> SEEPAGE PIT Gyl <br /> Depth_2 S .Diameter .ry f'.Num`ber >Z -_ ....?�. Rock Filled YpA No;[ <br /> ,r'+ µ_ Rock Size...G! ... <br /> Water Table Depth... - rQ..-,:w.es_•�. ,-..--_;fir ... i..i......}� . ... <br /> _-�..�. /.�0 °�' -�-•--, Foundatidn.... --. ...if.':.'..Prop. Line � :......'` <br /> Distance to nearest: Well"_......_._..__.....: -.-.-- <br /> REPAIR/ADDITION (Prev. Sanitation PermitA................. .................................Dd�e_ ^ri----------------------------------- <br /> Septic <br /> --------------------------- ---Septic <br /> Tank (Specify Requirements) .....,._..t.r�.........:..............__....__._.......Y:Y...._.....•--•. t <br /> Disposal Field (Specify Requirements)......................___--••.••_--•.•-. � <br /> 4i.......... <br /> c ..............:. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I havepreparedthis application and that the work will be done in accordance with-Son 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 net employ any Penson in such manner as <br /> to becom�rsubject to Work an's Compensation laws of California. <br /> Signed". rL , .. .......................... .Owner . <br /> .....................Title-__._.................................v.=:!`.- ............ <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... ... ... .. ...... - DATE L--- _s'3'?�------------------ <br /> DIVISION <br /> ----------- <br /> DIVISIONOF LAND NUMBER..........._.................•..-------..................................................................DATE. ------ .... <br /> ADDITIONAL COMMENTS..- -• ------ ...: ..........__..................... <br /> -- <br /> ------- -- ------------•---•------------------•----•--------------------------------------------------------------- <br /> time­ <br /> :->........................................._...........--------.. ... ,f <br /> - I,�-----��....- ------ <br /> - ... <br /> Final Inspection by:.-.... _ ___ -... ............_.Date._.. <br /> F6s 21 Nr REV. 7/76 3At <br /> et 12 24 V_ j_CAQUI(4C'CAL HEALTH DISTRICT - <br />