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FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> fPermit No..-7. <br /> ........................... <br /> (Complete in Triplicate) <br /> • - - • - � - Date Issued...�.:��.�� <br /> :,-_-,-„.......................................... This Permit Expires 1 Year From Date 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 w uu`IOrdinance No. 549 and existing Rules and Regulations: <br /> SUS TRACT. .... ....................... <br /> ADDNREaSmS/e..O... N - -- t�....N.+^.:. <br /> t.../:�.....v... <br /> . <br /> - - <br /> . ... � <br /> It, <br /> Phone..�. ..... . -...... <br /> Oners ................................ Wy �3......_.. <br /> . <br /> E ". ............... .....ciw...LN. - ............_.. ..- <br /> Address.....nnVso. / ....._.-.......`_...R. 7.^ . . <br /> .. _ <br /> ontractor's Name.......Qei.................................................... License #.......................... <br /> . .... ............. .Phone. <br /> tstallation will serve: Residence ❑ Apartment House o1nmercial ❑ Trailer Court El <br /> Motel ❑ <br /> v /3Gvtr7................................ .. <br /> umber of living vnits:................Number of bedrooms............Garbage Grinder./., ...lot Size._.... ..-......... ; <br /> ater Supply: Public System and name:................. ...•:...._........._...,...........................................:..................................,,........Private <br /> �haracter of soil to a depth of 3 feet:... Sand [-] Silt❑ -Clay [D-'.Peat❑ �Sandy Loam42r.. Clay Loam ❑ <br /> Hardpan ❑ • Adobe F-1 Fill Material.-..... ....If yes,type..!............................. <br /> (Plot plan, showing size of Iot,.Jocation`"df system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> PACKAGE TREATMENT [,J SEPTIC TANK. p g pit <br /> public <br /> Ce�available within qui feet,) <br /> EW INSTALLATION: (No cif ti`t�ank or--see e.a--- 11 - Size??.Morar ablic-sewer 1 ....................... <br /> ---- -- --- -- ------Liquid Depth.._::._....-.-.-_...---.... <br /> t\tl <br /> Cape Y p� Type_ :No. Compartments...- .................;_, <br /> ' / �� � <br /> Distance to nearest: Weil.:..ld-�. ...........Foundation........ ... .............Prop. Line..&o.. <br /> Q...............Total Length ..,.-.�'�Q....................C1 <br /> LEACHING LINE [ ] No. of Lines.......3.................Length of each line........ • N <br /> yy ................ .......................� <br /> 'D' Box-...:.`.....Type Filler Material.I o�......Depth Filter Material-.....�........._.. •h <br /> . . /-..f��.f��.F z . � <br /> Distance to nearest: Well.... .Q..( ..... oundatlon.............. ..... - . .Pro perr Y Line.... .... <br /> - M Rock Filled Yes No Mh <br /> SEEP [ 1 Depth.... Diameter.- 1- Number... ......... ...._... .---..,may �V <br /> Water Table Depth.__...._. Rock Size'�!1tA ----------------'••--.. Y�(/ <br /> Distance to nearest: Well---------:- --- -----------------------------Foundation....................._ ............... <br /> - _ <br /> ...Prop. Line..- --.....- ...-..... <br /> EPAIR/ADDITION (Prev. Sanitation Permit#.::...........:....................................Date.....---:--_-------.-- ._....._-------.---1 <br /> ek (Specify Requirements(.:.................. ...................................................:.... <br /> :• ......................... .2 <br /> ptic Tan <br /> Disposal Field (Specify Requirements).............:..:.: ..............................................:................................................ .:... <br /> ................. <br /> . ... . ........ .... <br /> .... ---------­---------- <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 /> t"I certify that i the arformance the ork for which this permit is Issue <br /> d, I shall not employ any person in such manner as <br /> o become b ct t r s Com nsation laws of California." <br /> Signed... . . .. ..... ..... r.........................................Owner aQ <br /> Title..... ..... <br /> .. � <br /> If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ,APPLICATION ACCEPTED BY.;. ...................................................DATE ........ .......... <br /> DIVISION 0.1 LAND NUMBER, __ .::i::...::::::: . .:. ,:::-:. _, :,._,;,,,DATE ;_ ; '_ ....':......,. ...`. .....E... <br /> AD§ITIONAL COMMENTS.,..........:.:.: .:.::...:...:::" .._. ...... :f ., .: . <br /> .. '......,. <br /> -ii - <br /> f.: <br /> [ ' <br /> ..................:.................. <br /> :......:.... <br /> Final•Inspetflon by:.....'....... . . <br /> FLt 81677 KV.7/7E 3M <br /> F.H 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />