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' FOR OFFICE USE: a FOR OFFICE USE.; <br /> APPLICAIONa.QR SANITATION PERMIT <br /> .03 Permit No...77-- <br /> IComplate in Triplicate) <br /> PewPewS /CrDate Issued. 3.... ..!V7 <br /> ....................................................... This Permit Expires 1 Year From <br /> .m Dafe 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 /> hIs application is made in compliance with County Ordinances No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATTIONj .... ..cJ . .:,r .T....��.._...._.�IK P1l---...CENSUS TRACT...4 Z.................. <br /> twner's Name..... ✓/o��+M...,.J_r ..../. /pRCJL.I�.:....7!r• ........................C`......../.................,_........Phone..��/.-.ys��.y........ <br /> ddress...j..�7..'3fp..✓ .e,.../,�fsFA ?..Ys�b....------------------------......... ty.i(�II 1t�....................zlp...". :7.73d......... <br /> iontroctor's Name........U��;W11 ................................................................License ........ .Phone... jl ............... <br /> nstallation will serve: Residence ❑ Apartm House[ Commercial ❑ Traller Court ❑ <br /> Mote <br /> 4V16 <br /> umber of living units:...1...........Number of bedroL <br /> .the oms, Garbage Grinder,#W...Lot Size....mI.A.ft....rf.... .. ,J....••. <br /> Later 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 ❑ Fill Material.. .... ....lf yes, type................................ � <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.[ <br /> EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer-is available within 200 feet,) <br /> ACKAGE TREATMENT [ ) SEPTIC TANK [ Size....,/ ---------------------I.. <br /> ..... ....Liquid Depth................... <br /> aterial. .C2GfCNo. Compartments.....a; ............................A <br /> Capacity.ZA00.... .TypeAa. -.M <br /> v ♦............Prop. Line_._'.-........._.... .Distance to nearest: Well--- ..... . - ................Foundtion .` <br /> REACHING LINE ( ] No. of Lines.......,...................Length of eac) Iine...140.•........... ...Total Length .. .. ... .. .................. <br /> a/ N <br /> ' 'D' Box.. _....Type Filter Materlal�lAe . .Depth Filter Material./.;/L:!71._..�Q 4�` .... <br /> e..._..__...... ... <br /> Distance to crest: Well.��! �... ��Foundation..f�-71".........•..Property Line../4.4...................... <br /> SEEPAGE PIT [ ] Depth..skS-_...Dlameter..s '............Number.....f----------------------- ,r Rock Filled YeessX No <br /> Water Table Depth..../".4.......................................Rock Size... p..t`:FY/11 ;-C(7Cfl . <br /> Distance to nearest: Well._..�j�Q.Q.f-........................Foundation.A40................Prop. Line./.1�..!*..._....._--- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#................................... ...............Date ...... .... -_-- 1 <br /> eptic Tank (Specify Requirements(.......... . .......................•---........0.................... - -- .....................................- <br /> ...........--.................. <br /> Disposal Field (Specify Requirements)....................... .............................. ..................................................................0.......................... <br /> , <br /> . <br /> (Draw existing and required addition on reverse side) <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> rdinonces, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> 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 /> So become b[e to Wo kma ' ,Cewm_palisation laws of California." <br /> Signed.. ............. .. ../dam" .. . .. ..........................Owner <br /> �y_....- . ............................... ...--------------- <br /> (If <br /> ------------ -- - .... Title _... - _ <br /> (If other than owner) <br /> OR D PARTM T USE ONLY <br /> PPLICATION ACCEPTED BY.... ... .e..... .. . . ... . . . .......... ... -.:. DATE A.Z. Y .. .;...... ......... <br /> (VISION OF LAND NUMBER.................. <br /> .......... <br /> ..................... ...................1....DATE....------------------...._.................... <br /> ADDITIONAL COMMENTS..!(a�y...j'twxAr-% _'d��t p�.�&liC� . a�.G.r�e�..........................................---......... .......... <br /> 00 <br /> .......................................................................................................................................... ...................•....................................... <br /> ............. .. .... .. <br /> ..................... <br /> inal Inspection by:..... ..... -. - .....---•----._....... ...... .............. .......... ......Date.... ress:aneev. r/rssM <br /> 7 .J? ..� <br /> rs s� SAN JOAQUIN LOCAL HEALTH DISTRICT <br />