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• -FOR OFFICE USE: <br /> This Permit Expires 1 Year From Date Issued <br />permit to construct and install the work herein described. <br />X Lot Size <br />Clay Loam <br />c <br />LEACHING LINE <br />SEEPAGE PIT Non <br />fCrQ(.± <br />7.8: <br />Final Inspection by: <br />EH 13 24 <br />DATE <br />DATE <br />V <br />T- <br />Silt Clayn <br />Fill Material . . <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />Signed <br />By <br />t)4 <br />...Type <br />CENSUS TRACT . <br />........ Phone<?rZ'-.<2.7.?y. <br />...-...Zip............... . <br /> Phone...^^4 <br />Trailer Oourf <br />Date ..... <br />F&S 21677 REV. 7/76 3M <br />........................................................................................7^-^............. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />r....... <br />.........License # <br />Commercial <br />NEW INSTALLATION: <br />PACKAGE TREATMENT <br />FOR OFFICE USE: <br />Permit No.z^^rr.Sj^. <br />Date Issued <br />; FOg DEPARTMENT USE ONLY <br />Private <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 shall not employ any person in such manner as <br />to become subject to Workman's Compensation laws of California." <br />Owner <br /> Title... <br />Peat Sandy Loam <br /> ...If yes, type ................ <br />Prop. Line. ~>..... <br />.......-1 <br />? ^ze . <br />... Ma ter i a I. <br />Z.QZ>....t Foundation <br />srd..'... <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />(No septic tank or <br />[ ] SEPTIC TANK <br />Capacity. <br />Distance to nearest: Well <br />No. of Lines OrT. <br />'D' Box <br />Distance to nearest: Well Foundation <br />Depth... “2^^Diameter... ....Number.............j. <br />Water Table Depth <br />Distance to nearest: Well <br />REPAIR/ADDITION (Prev. Sanitation Permit# <br />Septic Tank (Specify Requirements).................... <br />Disposal Field (Specify Requirements)........... <br /> <br />f other than owner) <br />APPLICATION ACCEPTED BY <br />DIVISION OF LAND NUMBER.............................. <br />ADDITIONAL COMMENTS <br />.... K? .^1.- .1 2.... efts-. .... <br /> glOiCZZ <br />name <br />depth of 3 feet: Sand <br />Hardpan Adobe <br />Residence Q Apartment House Q <br />Motel Other.. <br />Number of living units:——Number of bedrooms ..Garbage Grinder <br />Water Supply: Public System and <br />Character of soil to a <br />seepage pit permitted if public sewy is available within 200 feet,) <br />... ................Liquid Depth <br />No. Compartments . <br />Prop. Line. <br />'......... ... Length of each line ..sro..'..... Total Length Z.ot)..... <br />Type Filter Material..A^bA......Depth Filter Material. <br />. . f j-' <br />...f..Q Property Line J»......... <br />’^7-............. Rock Filled Yes <br />Rock Size.. ^/rX../.‘6^,./ <br />Foundation.CQ....^. <br />Date ...... ......... <br />Application is hereby made to the San Joaquin Local Health District for a |. ( 'T ' <br />This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />JOB ADDRESS/LOCATION <br />Owner's Name <br />Address ............ <br />Contractor's Name <br />Installation will serve: