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r-.•.sOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -.....------....._..---- Permit No..7.7.`. <br /> --- (Complete in Triplicate) <br /> r3-77 <br /> - Date Issued--.�.�'_........., <br /> v ___________________________ _ <br /> .._..-_-..-_--- _._ I This Permit Expires 1 Year From Date Issued <br /> __ i <br /> : <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. <br /> This application is made in compliance <br /> with County Ordinance No. 549 and existing Rules and Regulations; <br /> Regulations: t <br /> J08 ADDRESS/LOCATION --- ---._�-d--.+.�'9-_---�.._ t'l�.�Lc/!.J� .... t/ <br /> Owner's Name----_Gs---------R2G>V..D.1�rk1;7_P_&55...............__....__-._................-----------Phone----Y4W. 7!AS 4794 <br /> Address......... _.......,�.�!QM/ c.......... - .............-.....................................City---Ao..Q-.1........ .Z'p-- ------------ .-..._ <br /> Contractor allome...-.--•... <br /> - Y`�-iln-.rvl.44Ci 0�....- _ ..............__.....License <br /> installation will serve: Residence* AApartment House 0 Commercial [I Trotter Court ❑ <br /> -Motel E] c Other..........................------------------:V <br /> Number of living units;.... ._._.Number of bedroomsS_i-._Garboge Grinder.._........Lot Slze__/�a? <br /> Water Supply: Public System and name-------------_.:.•..._......-.....-•.._..........................._-- <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ ClayPeat C] Sandy Loot❑ Cloy Loam Q <br /> Hardpan Ej Adobe O Fill Material+......... If yes,type_....------- .-___.__..._ r <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 waitable within 200 feet,) <br /> : <br /> PACKAGE TREATMENT ( ] SEPTIC TANK ( ] Size__.................................................-Liquid Depth..... ._-----_._.-._-_- <br /> Capacity---------------------Type------..............Material---.- ............_.No. Compartments_;_------------------------•-8 <br /> Distance to nearest: Wall-------------------.......................Foundation_................___,-.Prop. Lina__--..-.•-__..�+,,,-O <br /> LEACHING LINE I 1 No. of Lines__._...__._.___.__._.Length of each line._____...-__. _.__Total Length... ..__. . _.. 0 <br /> 'D' Box----------Type Filter Material--------------.----Depth Filter MaferiaL_-_----------------.-___ <br /> • Distance to nearest: Well.............___...........Foundation-.-_•--,_-_____..._Drapery Line.t__._----..-_-------..-----.� <br /> SEEPAGE PIT I 1 Depth._..--. .......Diameter..•.... .......-...Numbw---....__---........ Rockkled Yes`.[] NoO <br /> Water Table Depth---­,_,.____..__.-------- ----------_------Rock Size._....._...-.,_-_-.__-.__-.-..t........._.� <br /> Distance to nearest:Well..........................._.....___.___Foundation <br /> " ys _.-.-...-_,.._.._._Prop. 1Line-_-.. <br /> REPAIR/ADDITION.(Prov. Sanitation Permit# ----------- -- <br /> .-.-.-. <br /> ' —_---.--__ <br /> U3 .�` <br /> Septic Tan (Specify Requirements).......... fl ----- - ---_-----------------------•------''----- ---•--• <br /> Disposal Field (Specify Requirements).....- ---•------_- -----------r•_,-_.-.-..-._, <br /> -------- <br /> ---------_ -3 - P <br /> a'nd u:red addition on teverse side) <br /> 1 hereby certify that 1 Have prepared this' Plica on-uad that the work vAll be done in accordance with San Joaquin Count <br /> Ordinances, State-L6ws,-and Rufei and It4ulat4ru; lof'the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the followitfgi <br /> `z r� <br /> "I certify that in the puvformancepof the work for which this permit is issued, I shad not employ any Person in such manner as <br /> to become subiect to 7man Osfe sallon laws{ef California." <br /> Signed.......j0 ..i.sfr-_- ^1�4.�f-+V �' -.-..Owner f <br /> r � <br /> •+ .~ . Title............. <br /> - <br /> (If other than than owner!' <br /> i DEPARTMENT USE ONLY <br /> v - - -- DATES-- - ---...._.._.----- <br /> APPLICATION ACCEPTED BY......... - - - -- <br /> DIVISION OF LAND NUMBER.-•-•---_---_._..._._.... DATE,,,,�:�-.-- .ur" • .`...:^.�... <br /> ADDlfk*AL-COMMENTS. .--^- ..___.._--- ----•---------------.............---------------------------------------------•--- <br /> _ .............. -..._.........._..__._ <br /> - <br /> ® -r- <br /> _ _ <br /> n wwrrow.w• by[ ......... .. . .. <br /> M nay <br /> M n s. SAN JOAGLIJiN LOCAL HEALTH DISTRICT 'rnrae <br />