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44` 'FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------ ------------ ---- <br /> (Complete in Triplicate) Permit No..'76�� <br /> -----------------------------=------------------------- is " <br /> Date issued--------�------------ <br /> ---------_-----------_-----------------------_----------- This Permit 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 Ordinan No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION __..CENSUS TRACT________________ _. <br /> ------- - --- . <br /> Owner's Ime-' - - -- -- -Phone - %' ------------ <br /> ------ <br /> .- <br /> Address Q � - - -'--- ` - Ci '' _ ZAP <br /> Contractor's Name_-------- d1.. ---- -, ® ._! '_ `.--------------------"------_----- License #_ _/h - _/_._"Phone? <br /> Installation will.serve: Residence' Apartment House-E] Commercial ❑ :Trailer,.•Court:,❑ <br /> Motel, ,'Other------------------- _. ---- <br /> Nu# ber of hying units:___.-------Nsumber of bedrooms} G .Grinder Size - <br /> ' . <br /> _.__ arbage <br /> Water Supply: Public System and n me - _ C" -'------------------ ------------------------ --------- --Private' <br /> Character of soil to a depth of 3 feet: , Sand ❑1\!Silt❑ :Clay ❑�P-eat❑ Sandy Loam ❑ i~Clay Loam �� ? <br /> Hardpan ❑ Adobe ❑ Fill Material......:__.._If'yes, type----------'_----- -------------- <br /> t f <br /> (Plot plan, showing size of lot, location of,system in relation to wells, buildings, etc,must be placed 0n_reverse side.) F <br /> ANEW INSTALLATION: (No septic ton or-seepage pit permitted if public sewer is available within 200 feet,] . t <br /> ' PACKAGE TREATMENT [ ] . SEPTICfTAN,I Siz ._ ___ ____:_____Liquid Depth----,:5------- ----------- <br /> /7 <br /> r Ca acit61 <br /> .. P. Y 'Type Materia .---------No. Compartments <br /> Distance to nearest: Well_.J� ----------------------- - --- <br /> --- --Foundation- e---------- Line--.------_-- -- <br />/ LEACHING-LINE----)d No,of-Lines--G.Z.: -.- ------- Length-of each-line._o* --_-----d-----------..Total Length.--- ,1 --------------------- <br /> lot <br /> 'D` Box_ .....Typ: e Filter Material�11ehwDepth Filter Material.___-/19_----- --` <br /> - <br /> 'Distance to nearest: Well---146 _- :_ Foundation e.---- -----------Property Line___6---- 9a, <br /> 'SEEPAGE PIT J Dept :_...Diameter 6. --Number_ _ __ Rock FilledL,;Yes _N­o_Z <br /> Water Table Depth--- ------- ----f=------=------I --- ---Rock Size:_ ' �]` ----------- ------------------- <br /> � f <br /> Distance to nearest: Well.---_�r��____________---------__-----:Foundation-__��_- Prop:lLine____.__ ------ <br /> REPAIR/ADDITION <br /> -----REPAIR/ADDITION (Prev, Sanitation Permit#-----=--------- - '__--:--- ------------`------''Date------.-------------------- <br /> ----------- <br /> Septic Tank [Specify Requirements] :: =; _ = `' ----`- ------ <br /> _,_ <br />-e Disposal Field (Specify Requirements)`------ ----- - -- ]------------------------------------------------- - ------------------------- <br /> [Draw existing nd required addition{on reverse side♦ ' <br /> I hereby certify that'I have prepared this application and'thot the-work will be done in accordancewith -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 1the following: <br /> 1.1 certify that in the performance of'the?work for which this permit'lls issued, I shall not employ any person in such manner as <br /> to becorn blect to W, n s Compensation',laws of California." <br /> edSi nE' ------------' . Ownerl - F Title - -$Y- ------------- ---- - . .[If other,_than oed - <br /> f� <br /> l <br /> : <br /> �. N, �` FOR DEPARTMENT USE ONLY, <br /> oc <br /> APPLICATION ACCEPTED BY - jl_ --------------- ' = '. = ------------ = DATE.. <br /> DIVISION OF LAND NUMBER;=-----:--.--- -__ ------DATE-:----.----__ 1% ' <br /> : . <br /> IF <br /> ADDITIONAL COMMENTS___________________. _ <br /> ] ----------------------- --------------------- -- <br /> ---------=--------------------------------------- <br /> s <br /> ---------------------------------------------------- -- -,----- ------- -- ---- _ <br /> - ------- - -------- <br /> ___ _ ________ ___ _ ____________________________ ______:.___' lel;-__-____ Esc �r _ __ _ ____._-- <br /> i { <br /> Final Inspection-by: ------------------- = - - -----------= ------- ------------Date -----------'-------- ------. . <br /> EH 13 24 SAN_JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />