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FOR OFFICE USE: FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT <br />yJ. (Complete in Triplicate) Permit No.,_>Iy-_1*3 <br />i Date Issued,lD__,3P: 8 <br />This Perm.it 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 />This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />JOB ADDRESS/LOCATION. 'i e -t:-_ ---__ <br />Owner's Name______ <br />g <br />Phone <br />c <br />City zip-----------------------Address <br />Cont1 .ractor's Nameett.,J J <br />t_,_ ice <br />Installation will serve: Residence AApartment House.D Commercial Trailer Court' p t <br />Mote!Other-------=---------- ----------------------- <br />NumberNumber of living units:.----- ------Number of b drooms:'-----Garbage Gr.inder_`- '-Lot Size.-.=-__ -__ -['/ t.c --- ----------. .- <br />tWaterSupply: Public System and name Private <br />Character of soil to a depth of 3 feet: Sand Silt Clay p Peat Sandy Loam Clay Loam <br />Hardpan r'-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: 7jNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT SEPTIC TANK Size { r Q ' Liquid Depth-<_- -.----------- <br />Capacity/,)4 - -_Type AZ Material--_ - -.---No. Compartments.-----.2;------------------- <br />Foundation Prop. Line `fir <br />W <br />1 Distance to nearest: Well_.., - Z. <br />Len <br />fLEACHINGLINENo. of Lines--.--- gg- <br />C--.- -- -_ -Length of each line.----- --Q,-- -- ----.Total Length.-: --------------'-------- _ ---- <br />1N+. D' Box----4_;_-Type F(Iter Material /& -----.Depth Filter Material--- l __------------------------------------------------ . <br />Distanca;to nearest:Well--`,S- V-Foundation--_ ______-------.- Property Line____4-------------------------- <br />SEEPAGE PIT ' De th __'- Diameter_ ? .__. --- Number_ .__----p, Rock Filled Yes ' No E] <br />hWaterTableDepth., ---Rock Size__-__ <br />f Distance.to nearest: Well._-. ___ ------------------------------_Foundation-------lQ----------:- Prop. Line__Is _--__------_- .. <br />riiPAIR/ADDITION~~(Prey. Sanitation Per it# at- - -----'-----_ ----------------------------------------- <br />e il,Septic Tank (Specify-Requirements)____________ _ __ <br />blsposal Field (Specify.Requirements)=--- ----- -- <br />F ._ <br />Draw existing ancl4e wired add it••ion-on-rev--------------------------rse side) , -________ w <br />I hereby certify that I haveprepared tthis. application and*fhat.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 t e following: <br />T <br />certify that in the performance..of thetwork for which this,is issued,'I shall not employ any person in such manner as <br />to become subject to Workman;' Compensation}law's of California.'- <br />Si ned i # I Gl 1, Eu ST G4':R SERVICE9t- Owners S S odd,,. , G Sif 9S2Oa <br />gY----- - <br />f• - -- - - - ,-Of oth"er an owner) <br />4 FOR+PIPARTMENT USE`ONLY" <br />1i APPLICATION ACCEPTEp_ 3Y._s - Y L * DATEA <br />DIVISION-OF-LAND-NUMBERDIVISION_OFLAND_NUMBER <br />ADDITOVAL COMMENTSs i <br />l€ <br />Finalrinspection;by. Date <br />SAN JOAQUIN LOCAL HEALTH DISTRICTEH1324s - '^ <br />F&S 21677 REV. 7/76 3m: