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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT ��_/S l/ <br /> v- ,. 7 <br /> .......................... .. <br /> (Complete in TriplicatalM ,...,,,,," Permit No. ._. . _ <br /> -•-•--••••. ........... This Permit Expires I Year From Date Issued Date Issued_-.3.oz�- 7 <br /> kpplication 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 Ordinance No, 549 and existing Rules and Regulations: <br /> OB ADDRESS/LOCATION....T,ll.19,.. ....�.....van len------K,40_�.................. -- --.CENSUS TRACT.................. <br /> )vner's Name...PA.. . is -�. .. ... . . ...:.. ......_...._...................... ..• .... -•--_....Phone ..----.......-----..........._...... <br /> `,ddress...----�� �1.ah`_AV( I' 1.. city...co`olr6p l.. Zip--.:.... ................. <br /> contractor's Name��r .. QYrI.S v\. -.2...... -5 License #-r1'•� .t_. ZPhone. �A�. .... <br /> nstallation will serve: Residence Apartment House ! ] Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other . . .... .. ............•••.................. <br /> slumber of living Units:.......I..._.. .Number of bedrooms....... Garbage Grinder..._ .._ ...Lot Size--------- _...... ... . .... <br /> Vater Supply: Public System and name Private ❑ <br /> '.horacter of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay rJ Peat [I Sandy Loom,K Clay Loam ❑ <br /> Hardpan ❑ Fill Material . .... ....If yes, typeti........................ .... <br /> 'lot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> IEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( <br /> 'ACKAGE TREATMENT SEPTIC TANK � Size ................... ...... ..... Liquid Depth...Ct.4................. <br /> Capacity ....1&..D.Ca._Type-�J� `Moterial__CD.-rr+-C ,, ..No. Compartments.__...Zi_.................. <br /> Distance to nearest: Well._ .t trC...-t-----------1.---- ---Fou ation._.._.(U --.1' Prop. Line ��- .`...... <br /> EACHING LINE ..___....._. Length of each line........ . ..Total Length .. .1 -.....�. ... __.. <br /> ( No, of Lines. . . ............... Q.____..... . <br /> `D' Box. . Type Filter Material................... Depth Filter Material.. ... ........ .. ....... ................... ....._.. ._....- <br /> Distance to nearest: Well ..�pt2.. .......Foundation.... ..Property Line....!t?.+........ ....... <br /> EEPAGE PIT Depth....' adDiameter.._ .. . :. umber. . . .-....... ............ Rock Filled Yes ❑ No❑ <br /> ao/ Water Table Depth------------------6- .........'t'..... ... ..........Rock Size.. 3�{ X 4..�� - ... . .. <br /> Distance to nearest: Well....(.00. --r .....................Foundation...(0-A- . ......Prop. Line._.l_0 _'I''.......... <br /> EPAIR/ADDITION (Prev. Sanitation Permit#....../.............. . ..........Date........:............ ................) <br /> e tic Tank JSpecify Requirements) ................. <br /> )isposal Field (Specify Requirements) ...... -............ ................................................................... . ................................... <br /> -------- ----------------- - ................ ............ . ---..._...................------. •........ .. -I——........... --•--................_...__.................................... ... . ..... <br /> ...----••...:..... ............... ................ --- ...-----------..._......._.. .. .... . .... .. . . --------.._......I ..................................... .......... ........... <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 /> )rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> ignature certifies the following: <br /> 'I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as <br /> o become subject to WRrkq�ae�,� pe a o f California." <br /> RRIS <br /> i ned.... - - L• H• i'Rt1 6� lJl'��, INL. <br /> ............. .. Owner <br /> POST OFFICE DOX-11450 <br /> lY-•-- --- --------- -- '..----STOCKTON,..CALIFORN A.YRO....... ..... Title... `4..........._..._ -----.----........ .............._. <br /> (If other than owner) <br /> FOR DEP RTMENT USE ONLY <br /> kPPLICATION ACCEPTED By....... DATE . 3=24-.71................. <br /> .... . ..... <br /> DIVISION OF LAND NUMBER.............................. ...... ...... QATE...... ...................... . <br /> kDDITIONAL COMMENTS....................... . ............................................ <br /> ........................... . . .........................-•----...........---•---•------......... ..... .. . .................................... • ............................................... <br /> ................................. . . . . .._................ .. _.... . .........-...-•----------------------•-•---- -- ......... . ....... <br /> :incl Inspection by:.....1i1/../P . .............Date.. ... ............... ..--- <br /> 'M 12 9e. cA I W%AfN111KI If.f AI uCNITu MICToirT F&S 21677 REV. I BM <br />