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•:,~rte: <br /> r <br /> rp FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> ��JX� <br /> (Complete In Triplicate) Permit No...7��-5 <br /> This Permit Expires 1 Year From Dote Issued 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 /> This application is made in compliance with County Ordinance No.549 and existing,Rules and Regulations;- <br /> JOB ADDRESS/LOCA " / '`f?'j�✓ <br /> G.. ... !�.��1�..!/... .�(7�GO(:. .' CENSUS TRACT. <br /> i . <br /> �cld <br /> wner's ams i f �.. ✓....._.t�✓�s;"f L -,/zrti� G^ e i Pe + <br /> .. ........ honress. ..-.. All.0 .•... ..City ... ✓.. .1'...(�Ua/..Zip <br /> ,r <br /> Contrac or's No w <br /> .License 4�;r� .7//_L...,. Phone <br /> Installation will serve: Residence Apartment House Commercial <br /> // ❑ P ❑ ❑ Trails feerh-ti t S <br /> Number of living units:..._l........Number of ,tel C] _Other -: ..:.:.:........ ....- -, ?- <br /> + o / <br /> r <br /> drooms.,-..::....Garbage Grinder.-' Lot S r } <br /> Water Supply: Public System and name. ..'f..'t. �!y:'!�t........�(: f. � Prr�ateAr <br /> y <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sar jy Loam Cj•_ ,Clay Loam ❑ r ' <br /> Hardpan ❑ Adobe❑" Fill Material . .......If yes,type......... t <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse sidd) „ 41, e i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r Rn <br /> PACKAGE TREATMENT ( 1 SEPTIC TANK / w . r!l(. � .' . •.......... ...Liquid Depth4 <br /> •, spl �MCPa� s.LeDanceo nearest: <br /> Foundation. /�. �mProp. i <br /> LEACHING LINE f No. of Lines... . ................. Length each line.../' f�.. ...:.. .Total Length / t r ti a <br /> 'D' Boxy'?`.. .Type Filter Material Depth Depth Filter Material..., t <br /> Distance to nearest: ^ ... ..Foundation . .. .Property <br /> : <br /> SEEPAGE PIT �/� Dept1x f. .. Diameter. . Number. f/ Rock Filled Yes 'No'❑ 1 <br /> Ar Water Table Depth...:. ll o'T 1� <br /> 0:.. ...Rock Size.... <br /> Distance to nearest: We . .. Foundation. �� Prop. iki s,JI <br /> Line, <br /> x' REPAIR/ADDITION (Prev. Sanitation Permit#.... .................. .............: ......Date.._....... ) <br /> Septic Tank (Specify Requirements).:.....:...... ... ..................: ... ...... E <br /> i <br /> Disposal Field (Specify Requirements)..... . . ........... ...................... . ........... . ........ . .... ,...... .. �l . <br /> ... .. ._ ...-....... ...... ............ .... . . <br /> ..... . .... .... .. ... . . <br /> _ z <br /> ........ . . .......... .. .... ............ ... .................... ..... ......... .......... .... <br /> (Draw existing and required addition on reverse side) <br /> - <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 i <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." CLARFNCE'S SEPTIC R SEWER SERVICE <br /> Signed .� - - - .- Owner 263 So. Oro a Stockton, Calif. 95205, <br /> ✓li��, ��, ���/ Ph•463.3799 Conjracto('5 Llc•. .2671.7T. . .... <br /> . Y; <br /> Bf..e..wC�....:... . ......_ _�_... ... . . .. . . ...Title ......... .... ... <br /> (If other th9 owner) <br /> O DEPARTMENT USE ONLYa+?t <br /> APPLICATION ACCEPTED BY...- .. .. ............ .. __.. . .:.. _... . _._ <br /> DATE <br /> DIVISION OF LAND NUMBER,... .. . .. . :.:... . . . . ......... ... .. ...... . .. ..... ....... .... ..DATE..... <br /> ADDITIONAL COMMENTS .... . y • .... ... <br /> .. .. .. <br /> ......... ... .. ext . <br /> ........ .. .. .. <br /> .. / . .. <br /> FinalInspection by: .... >✓ .._.... .... .. .... . ....... ........ ..._ ..... .. ....... . ............:............ .Date .... - /.-.�-7-7� .. .....,....:. . <br /> EH n a. SAN JOAQUIN LOCAL HEALTH DISTRICT F6s 21677 stv:7/76 3M• <br /> cMg wa <br /> a.. <br /> fw,.,:•...., r. ..„ did:^..•d,,. t:;„i .N_.:;'1 t..,y,... ;_.r+.w.,N--��. '°i�'a�.:.�.e.„+�..k.,,,_�x,.� =�Ut»i3••.,��'�°r:,�/etFiY,'.'.Xn�.h�J?s�:N'7�Y <br />