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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMITS �QL <br /> - <br /> ------------------------------------------- . <br /> (Complete in Triplicate) Permit No.. ��-�---��-�------ <br /> - ..... ---------­----------------- -------... �-3-7 <br /> Date Issued__.__ <br /> ------- ___-......._ --------- ....______._... This Permit Expires I 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 /> This application is made in comp/l�iance with County Ordinance No. 9Jand axis ng Rules and Regulations: <br /> JOB ADDRESS/'LOCATION. _ . 2.�-Q-O---_ C1 `-Q.-�._- - -C�_.^�r\�L'g ---CENSUS TRACT�L�......_.-...-._ <br /> Owner's Name-'00091 . ---4'C06O.I-------.--. !k/S:T--------------.-------------------Phone---------------------------- <br /> Address -- ------------ - J7_2 � 6 . 1.& C'ty �------,--/-�---- Zip-------------------- -- ------ <br /> C <br /> Contractor's Nome.7.A,.�_R/_r`f.31Y-_- _-_Seiw-P-.--ZK ___-----License #.-�S�j .7� r.-Phone-�6�+����.--. <br /> Installation will serve: Residence,Q'�, Apartment House❑ Commercial ❑ Trailer Court ❑ <br /> Number of living units:..../- Motel ❑ Other---- ---- --- ------------------------ <br /> ...Number of bedroom._-Garbage Grinder........__Lot Size.�f)icR S._.__ <br /> Water 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 0 Adobe ❑ Fill Material------------If 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublic sewer is available within 200 feet,) <br /> r i. <br /> PACKAGE TREATMENT [ ] SEPTIC TANK pQ Size-S_-04- __..----.----._---_.---.-.-_Liquid Depth_ �r�--.__.__-. <br /> //�� S 1 <br /> Capacity.M.Q10-.-._Type �LCLa<f._.Materiaf_ a"e&_ 1 t._--No. Compartments-.._6a._ .-.-_____.... <br /> // Foundation.- //-y--e p / <br /> Distance to nearest: Well-..i0- -----_---------------- - --- Z------- ----------- Line._---0.--.-.---._-_---- t <br /> LEACHING LINE kf No. of Lin .__________ Length of ea line.... Q_�.--.-------.Total Length.-_1,, 0----------------------- f <br /> D' Box.'....-_--Type Filter Materia - .. Depth Filter Material..-��-------_-_-----_-__--_----------------__- <br /> Distancc/e��tonearest: Well_46�2---------------- oundation_2,5--.-..-._-.._Property Line._----Y-_ ----------------- <br /> SEEPAGE PIT 64 Depth 25..._-Diameter..uYr. ........Number... ---------------------- 41 Rock Filled Yes,[< No f <br /> S' '3�------------------- <br /> Distance <br /> �� <br /> Water Table Depth--_5.--_--:'[ ;0--------------- Size_./f --- ,� <br /> Distance to nearest: WeILfi.. ...___-._..__._-__Foundation_--e.C.. ---.---..Prop. Line----_!r--.._.._ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.___.___ ---_-___ ----.------- ---_----cDate______________ --------.--------- <br /> Septic Tank (Specify Requirements)_____-_.-__._ ` <br /> Disposal Field (Specify Requirements)_----- ---------------------------------------- ------------------------------ <br /> --------------------------- ----------------- --------------------- ------------------------------ ------.------------------..._----------------------- ----------- -- <br /> ---------------------__ ......... ------------------------------------------ <br /> (Draw existing and required addition wn reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coi <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed age <br /> signature certifies the following: <br /> "1 certify that in t performance of the work for which this permit is issued, I shall not employ any person in such manna <br /> to beco sul�jetf\fo rkm 's Co p nscman I ws of California:' <br /> Signed- `-.� 1� .` ..o1.4zG�... p --./.I - „9""_ <br /> BY - - - ........ <br /> .... ✓ U-6'L -.Title - <br /> (If other than owner) /f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - /p ------------------------------------------ -DATE..-- -C) --��J- 777... <br /> DIVISION OF LAND NUMBER .. . . ------------------- 7 ----------------------------------------------------------DATE-- ---- ------------------- --- <br /> ADDITIONAL COMMENTS.. - ------------------- --- <br /> ---- <br /> ---- <br /> — — ------------- <br /> Final Inspection by: - - - - Date -- .-4d _(. . <br /> Ex is 44 SAN JOA UIN LOCAL HEALTH DISTRICT <br /> F85 416]7 REV. 7/74 3M <br />