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FOR OFFICE USE: FOR OFFICE USE: <br /> 'i//APPLICATION FOR SANITATION PERMIT <br /> ---•--......-•-------.........................• • - Permit No. .�._ld#i�_ 1 <br /> (Complete in Triplicate) i <br /> ---•---- ----•------------------------------------------ . <br /> Date Issued-/1-.�.�.�8' i <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 Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.....9 --.....So. ?7/.. L� 4R... .....-Yr/G9y...................... .. ..,CENSUS TRACT._----------------_-.....---- <br /> Owner's Name.... . <br /> S79- 339% <br /> `. 174.1�G°o7`- H - --.Phone.... <br /> Address 1. //.... .. <br /> So,..-2'r/' .���5!^`! s -Wt � = .......Cir f.°-- --------- zip p ..-... <br /> Contractor's Name- ! <br /> Installation will serve: Residents ® Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other............ ------------------ <br /> Number of living units:__.._..........Number of bedrooms----3__._.Garbage Grinder............Lot Size-- -9!gNG�------------ ------------- <br /> .Water Supply: Public System and name.......-. --- ----- ----- .................................. -•--•-------------------- --.....................private <br /> Character of soil to a depth of 3 feet: Sand`} Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material.. .... ....1f 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 'I <br /> PACKAGE TREATMENT [ ] SEPTIC TANK j } Size-- ---- --------------------------------------------------Liquid Depth.------------------.- -----5 <br /> Capacity....... .............Type-----------------------Mate-tial----------- --------------No. Compartments..-.-_------- ---_-------------•til <br /> Distance to nearest: Well-:---------- ------------------....Foundation......... ........Prop. Line------------.-.----.---- 1 <br /> LEACHING LINE [ } No, of Lines ............................Length of each line....--- ----------------------Total Length ........--.-... <br /> 'D' Box--- ........Type Filter Material_ .. ...........Depth Filter'Material-------..--.------- ......-------------._.------------.--------.� <br /> Distance to nearest: Well......74?1 __---Foundation------------------------- -Property Line-.--.--_------------..-- -------- <br /> SEEPAGE PIT [ ) Depth--- Diameter................... ----- Rock Filled es <br /> .Number.. ---••-•-------------••- llY ❑ No ❑ <br /> Water Table Depth------------------ ---------------------------•--.Rock Size----._.........._... .................... I <br /> Distance to nearest: Well--------- .. -- ------Foundation •........................Prop. Line------- ----- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------------------------------- ---------------Date__----------------------- - ------ ----------) <br /> SepticTank (specify Requirements)------ ------...-----•----------------------�-- --- - --------------- -•--•----------- - - -... ------- ----------------------- ....... <br /> Disposal Field (Specify - ........... ......... <br /> -i Irl ---------5 't----------------------------------- -------- <br /> •-- -- ------ ----- ---------------. ------ -------------- ---------------- ---- ----- -- -------------------------- -- ----------------------------------------- ............. <br /> (Draw <br /> --- - ---- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that 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 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 /> to become subject to Workman's Compensation laws of California." <br /> Signed--------JP�.-"7'1)dK-f----�_5e,&- ---Owner <br /> By... ..-. ... .................... - -.Title - ----------------- ------- ------ ... ---------------- --------- <br /> than wner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ -...-. ----------------- --- -DATE . . ZZ`---- ---- - ------•---- <br /> DIVISION OF LAND NUMBER... .......... --.....DATE--------------- ------------- - ............... <br /> ADDITIONAL COMMENTS- ----- ----------------- ---------.-..._ ------ ------.-_.---.---- .... <br /> ----------------- ................... ------- - ------ -.- -------------------------- <br /> ---------- -..--- <br /> Final Inspection b ---- --- --- -------------------------------------------- ------------• ...... Date./ Zz'? ....... . ----- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT res 2677 REV. 7/76 3M <br />