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FOR OFFICE USE: <br />...... .... .. ........... ...... .. ....................... <br />r <br />APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br />(Complete in Triplicate) Permit <br />............ ................ <br />�+ Date Issued-.�••-_#.-78' <br />••------- •------------•- -- - <br />This Permit Expires 1 Year From Date Issued <br />pp rcationis ereby ma a to the San Joaquin Local Health District fora p6r _ t:fo 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 .. _ .....__ ._ .- --• -----•-i1-r--- - -- .. ._CENSUSUS TRACT_...P ......�..,./ <br />" <br />-S <br />Owner's Name.:-- � <br />--• <br />Pon ............ <br />Address• ' , <br />�' City <br />Contractor's Name_.....__/1cs1'+_.. '- ��_ '"�s- # 3'zb �' Ph <br />-- <br />Licenseone- ................ <br />Irlstallation will serve: Residence ❑ Apartment Hou ❑.- Co mertipI ❑ Tr iter Court ❑ 7 <br />Motel C ; OtFier...:..-------is. �sa:. <br />Number of living <br />I units:._'.............Numberof.bedrooms_..,... Garbage.Grindex..':-,�...L'ot.i---------------- ._...::.,_ <br />Water Supply; Public SYstem and name...___ L.4."744 . d <br />... � <br />P. <br />_ <br />Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay [f Peat ❑' Sondy Loam ❑ Clay Loam ❑ <br />I t Hardpan ❑ Adobe (] Fi1I Material�-4-- .If ye's`type�3 ." <br />_ r y <br />(Plot plan, showing size of lot, location of. system in relation to -wells, buildings, etc. must:be'placed on reverse side.) rn <br />NEW INSTALLATION: " i• ` "• ` <br />(No septic tank ;or see ge pit permitted if public sevver"isavailable within 200 feet,) • <br />(' Size. / 0. X•:r <br />PACKAGE TREATMENT (J i SEPTIC TANK = �+ } // <br />----------.Liquid Depth --T.::..._:} ..... <br />• : t <br />t Capacity.-�_.f?O':...:.Type.. i,:Aaterial - �-----No: Compartments. ----Z----- ----- - <br />1 Distanceao nearest: Well ...... ,..L O fl _. <br />------ -•,.. F ndation...._......... __Prop. Line_.____.... <br />F' r �....._.. <br />LEACHING LINE' (!�No. of Lines........:..:........Length of each line7� <br />�^.._.-.Total Length.._._ �-�� <br />D' Box ............. Type Filter Material.•___�.1 ..;.Depth Filter Material._ <br />Distance to near st: Well ___.._�.d-d: Foundation~--!..1�'t�_� ..Property Line._: ..... �------------- <br />G <br />_ -_-_._... <br />ll� <br />SEEPAGE P!T Depth_. _ iameter_:.��rNEer'..=_._._�.. J N <br />• <br />( Water Table Depth ) __. "_-.`" "Rock Size:__.._.i.�. . + <br />Rock Fill Yes o <br />I Distance to' riearest: Well ._.._ f_=.:�D _ Foundation..'_'" i�' Prop. Lirie..... $ <br />REPAIR/ADDITION (Prev! Sanitation Permit•#-- -.--.;•:-•-•-•----------------- Date ------ :'.:...---:-'....... :.:............... <br />J ' <br />Septic Tank (Specify Requirements) ........... .......................: ........................ :`- <br />_::..... ------------------- <br />i <br />Disposal Field (Specify Requirements):-:. .................. --=----------•-•-••-------------•---------------•---- ,•.... <br />.......................... <br />(Draw existing and required addition -on reverse side) -; �- - "` <br />I herebycertify that'] have f <br />Y prepared this application and that.the work will be done in accordance with San Joaquin Count' <br />Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br />signature certifies the following: . <br />"I certify that in 'the 'performance of`the work *for which' this permit is issued, I shall not employ any person in "such manner has <br />to become -subject to Workman's Co nsation: laws of California." _. <br />Signed...................... ---- ... •----- --- - Owner <br />BYJ....... -:.... ----•- ------------- <br />_.- :...Title <br />-'•'�--ls� le <br />-- # <br />(If oche than'owner) <br />',FOR DEPARTMENT USE ONLY-,- <br />APPLICATION <br />NLY <br />APPLICATION ACCEPTED BY...: __..1�_ � <br />DIVISION OF LAND NUMBER: ----------------- ... ....� <br />ADDITIONAL COMMENTS .................... ....... ...... •---------=- . <br />----------------------- <br />Final•Inspection by: <br />EH 13 24 <br />. <br />-...._.._.......:...............•- DATE...2- % p ------ <br />........ 7 ----------- -------- -.;------•--•--------------:----.DATE.....................:...... :... <br />•-----:--•--------••-------- ........... .................. ........................ ---------­------ <br />. <br />-------- ------- .. +.... <br />• I <br />.......................... ............................... - <br />................................--------._..._----•-------------........._..--•-------•-------------._.__.-----._.._-• .---- <br />- ------ - - - ----------------Date .�•`- . _.... G <br />N JOAQUIN LOCAL HEALTH DISTRICT FAS ?1677 RFV. 7/76 3M <br />