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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ', _ ; <br /> 6 <br /> (Complete in Triplicate) Permit No._.7.-___ -'`____ <br /> 4 = = ` � <br /> Date-Issued--- <br /> /.7 '_,;2C"7dr" <br /> -••------------------ ----------------------------- L._. 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 describ d, <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS LOCATIONe2 +� <br /> f: <br /> ----------=- ---.CENSUS TRACT---- --------------------- <br /> Owner's Name._.` Lcr✓-CC„_._..G/-/L(ld ----_ : ■ <br /> . n -------------- --------------------- �': - <br /> 3 ` X r Vit/-_ /_ � Phone <br /> Address ,J_ - City ----------Zip --=----- <br /> J ----------- 3' <br /> Contracfior's Name-_._.____ ,_( License Phone_-— <br /> ,l E ' _._. ------------- <br /> Installation=will serve: :IResidence r Apartment House.❑ Commercial ❑ 'Trailer Court <br /> Motel.❑ Other---- � - -'- .- -- <br /> 1Nu g f h oms- ' = Garbage-Grinder---- ----' Lot,.Size--- ` r f = - = j <br /> Watebr Suof Vivi PLbine 5. stem and Nameer of bedro, - - . <br /> pp Y _ Y Q^� = Private I <br /> i� _ i :.• <br /> :- -.._ --- <br /> Character of soil to a depth of 3 feet: Sand [] ° .Silt❑ :Clay El ° -Peat E] Sandy_ Loam ❑ Clay Loam ❑ <br /> Hardpa Adobe ®" 'Fill Material <br /> ❑ .-.--_---=.If yes, type-._k_•- ----------------- --- -- <br /> (Plot plan, showing size of lot, location of systemein relation to;wells, buildings,:etc.4nust be placed on reverse side.) i <br /> NEW INSTALLATION'-' (No:septic tank or seepage -pit permitted ifpublic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ .J SE DTIC TANK Liquid d <br /> � � Size - -t ------------------- - ------ ---=---- iquid Depth.-------------------------- <br /> Ca acit,, Type --material- *____._*,,No.-Compa`tments.- ----------------------- ----- <br /> Distance to.nearest: Well._____-- --_ <br /> r --------------- <br /> :-.--Prop.= =,_.Prop. Line------ ----- ----! +� <br /> nda <br /> LEACHING LINE. [ ] No. of Lines.------------------- • - ,.Length of each lin®_-._-_-. ' __.Total Length ---------------- <br /> -. <br /> ' D' BOX-:.___ Type Filter Material_;_._ --._- Depth Filter Material---------- <br /> ------------------------------------------------ <br /> t <br /> y ----------- - ----- ------ <br /> Distant <br /> e�to nearest: Well-------- :-------------Foundation----------------------------Property Line-----------------__ <br /> SEEPAGE P17 P -- Diameter--------2- ------Number- = R Y N <br /> Yes- --=- Rock Filled s o ❑ <br /> ..` { <br /> 41 <br /> Water <br /> le __ ----------------------------------------- Rock Size--: <br /> tDitanaoneaest: Nell_'_ -. Foundation : <br /> -----.---._- _-------.Prop Line ------- ------------------ <br /> { <br /> REPAIR/ADDITION (Prev. Scinitati, ,n PermitDate <br /> Se tic Tank.(5.(Specify-Requirements).. <br /> - �r . fa' ------------------7--- <br /> Disposal <br /> ------ - <br /> Disposal Field(Specify Requirements) <br /> ----- ---------------------a i <br /> ---- ---------------------------= ----------------------------------------- <br /> s} _ <br /> {Draexisting and required addition on reverse'side) <br /> I hereby certify that I have prep red'this application-and that the work will be don <br /> e in accordance with' <br /> w San Joaquin County <br /> ty <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 <br /> issued, I shall not employ any person in such manner as <br /> to become sr�Workma is Compensation laws of California:" i <br /> Signed-=-------- ' ' <br /> -------- <br /> ByJ --.-Owner <br /> l <br /> Title.--- <br /> r �_. <br /> 1 (If othethan ow r) <br /> I � <br /> ` FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY`: """ ------ <br /> ------- ----------------------• ? = DATE.. ---- <br /> DIVISION OF LAND NUMBER. --------- ------------------ ------------------------ -- --- --------DATE.---------------- <br /> - -- ----- <br /> ADDITIONAL COMMENTS--- ---------� = <br /> ------------------------=------ <br /> -------- <br /> ------------------------------ ---- <br /> --- ---------------------------------------- ---- <br /> ------------------------------- - <br /> -------------------------------------------------------- - -------- - <br /> Final Inspection by: = - _ .. <br /> - ---------------------- ---------- ---------- ----- ---Date-.--- --- I--------------_------- <br /> eH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV, 7/7 3M <br />