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FOR OPF(CE USE: APPLICATION FOR SANITATION PERMIT PermH No. ........'... <br /> ............ . . :... <br /> . ........ .... 76 /a sC <br /> {Cempfete to Triplicate} <br /> --. This Permit Expires I Year From Date Issued <br /> - - Date Issued <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to.construct and Install the work herein <br /> described. This application is made In compliance with County Ordinance No. U-9 and existing Rules and Regulations: <br /> -07{� n <br /> Owner's Name ' ly+... ..-- �? dS.�l'.............................. .CENSUS TRACT .-..-.-....-.__:.... <br /> JOB ADDRESS/LOCA./.. ' ...-.- /yt eA.t. .....................................:.......... .:....... .... ..Phone �fbL.-.�.�� �........... <br /> Address ..............�.7.�..... �.-...-�Y`.W.. Sar- !!ilk 2:Et <br /> city ..:. ......-.-......_....... ............. <br /> Contractor's Name ...............i ...R'v?%(,Q ._. ...-SPu ..................Licestse i1iphone 6�?-.cl•K6.7-..- . <br /> Installation will serve: .. a Residences.Apartment-House0-Commercial QCraller Court O <br /> - Motel 0 Other........................................... <br /> - <br /> Number of living units;..... .-.-.. Number of bedrooms ...f.-...Garbage Grinder ............ Lot Size :.....��-. -�.............. . <br /> Water Supply: Public System and name ...........---...................._.-..-..............._.......-...._.....................Ola........Private C1 <br /> Character of Sall to a depth of 3 few: Sand n Silt 0 Gay p Peat Q Sandy Loom 0 y Loam ❑ - <br /> Hardpan 0 Adobe fill Material ....-..-....If yes,type............... ...y ..... � <br /> (Plot pian, showing size of lot, location of system-in,relation to wells, buildings, etc. musf be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feetd <br /> PACKAGE TREATMENT [ I SEPTIC,TANK{ ] size.................... .::: .................... Liquid Depth ......................... . <br /> w Caparity 'E- --.__..._--- Type -----_--•---_---Material...................... No. Compartments <br /> Distance.to nearest: Well _....... �..•--:- foundation ...................... Prop. Line.............: <br /> LEACHING LINE [ ] No. of Lines ._...................... of eachline............................ Total Length ............................ <br /> • 'D' Box Type Filter Material .............Depth Filter Material ....-....................................... <br /> i . <br /> - �. `.Distance to nearest: Well ....------------------ foundation _.......... ........ ... Properly Lina .........-............-. <br /> SEEPAGE PIT ( I Dept4 .-'.I.............. Diameter ... ...... Number ..........................:. Rock Filled Yes Q No Q <br /> Water Table Depth ...................__........................Rock Size ................................. <br /> Distance to nearest: Well __.........__......................foundation .................... Prop. Line ..---.......-..-...--- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------- --- `-1---�_-7----- -... Date ............-......-.............. <br /> ) <br /> Septic Tank (Specify Requirements) ...:....----•�! ---..Yd...-. ....... ......:_. <br /> t u .. <br /> 2 p -._....-..__........•-•-• .- <br /> Disposal Field (Specify Requirements) -. -..? ...._X. ?...•- .. fir/ ........ .................................... ..... - ... <br /> I <br /> It <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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healdt.DlsU}N. Home owner or Ikon- <br /> sed agents signature certifies the following: - t <br /> "1 certify that in the performance of the work for which this permit is issued, I shelf. net employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --.......... ........_..... ._.... - i------ - --- Owner <br /> By ..-............. Title ..... _ .... ................... <br /> 1, tffan owner) <br /> l r 1 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... .. _. ... DATE�.a-_'/d''. �z.................... <br /> _. <br /> BUILDING PERMIT ISSUED / -._.._... ..... DATE , <br /> ADDITIONAL COMMENTS -...r..t lfLG C: -...-..---• ---'--......_ .......... .......-.....---_.............._ ....---......-.... <br /> ......... --------- ....................... <br /> i <br /> `...__........._...............------............ _-- . . - - -_..._.. _-. <br /> ,inai Inspection <br /> --_.--.._....;..._-CQ�rtd.................................................. . ...............................Date ......l.'� ..LS.. ..2-1a..-.... <br /> EH 13 211 1-68 Rev. 5M SAN JOAQUIN. LOCAL HEALTH DISTRICT B/?b 3M <br />