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FM OFFICE LISE: FOR OFFICE USE, <br /> � APPLICATION FOR SANITATION PERMIT y <br /> .....................»*�,...�.._. ... R+ Permit No... A. ." <br /> {CeP etc in Trip icatei <br /> .. •. ._.. <br /> � /' <br /> • t Date Issued..�.'"`��-,.7f <br /> „--.,,...-- ---- -- This Permit Expires t Year From Dot* Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to ronstrurt and install the work herein described. <br /> This appilcotion is made in compliance with County Ordinance No.549 and existing Rules and Regulations: <br /> 04, <br /> ' Lr . 'JOB ADDRESS! O TION J ._ ..- . . <br /> Owner's hJame -700 <br /> �G..•-. �s .._ �.r..--•-- -------- <br /> Phone-- ,� <br /> Address.. t ,............... ................,, .. ...................._.» City 4 .�.._...W.............._—Zip.............................. <br /> Contractor's Narne ' .... , . ..% -�. Tw 't License #..JP> Phone..AANK <br /> Installation will serve; Residence Q Apartment Hous4=7 <br /> mrciahQ-'Trailer Court ❑ <br /> Motel ❑ Other --------------- <br /> Number of Iiving units:...- Number of bedrooms . -...-C+arbage Grinder»......... Lot Size-..................._............................... <br /> ...... <br /> Wafer 5uppiy: Public System and nctttie.......,. .............. ................. ......................,...........................,,.....Private -- <br /> Character of soil to a depth of 3 feeh Sand ❑ Silt ❑ Cloy] Peat(] Sandy L*om❑ Clay Laarrt&�-- ..._ <br /> Hardpan ❑ Adobe ❑ Fill Material.. ..--.... If yes,type__...... "~ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION; INo septic tank or seep ge pit permitted if pubbkc sewer is;vail 41e within 200 feet,) ,f <br /> PACKAGE TREATMENT I 1 SEPTIC TANK I Sixe.._.._�f' �lF'_�ls..���"...�..._b.'?...Liquid Depth 1_.._. . <br /> Capocityla1409W. Typsi_.R�...r....__.Motedal_. SAV.........No. Comportments �.--- ----- <br /> Distance Foundation- •....-. .. <br /> r y/ [] <br /> Distance to neatestr Wsll.__.,-,,��.. � .•.._._ Prop. Line............. <br /> ._._....�....�._...-•--••--•---•- <br /> LEACHING LINE �No. of Lines....... Length of each line-------------�-�•_-- Total Length --.._ Q{ <br /> 'D' Box.ji"�Type Filter mwerial./! .Depth Filter Material....... .....—...._....._..._. ................. <br /> r <br /> Distance to nearest- Well...+ f`r�y......... .. Foundation......�O....... .....Property Line.....~ _.__...........» <br /> SEEPAGE PIT W— Depth -� f Diameter r� Number.- .-----Zr• _......... Rock Filled Yes{ jo,"No❑ <br /> t � <br /> Water Table Depth ....................... . hock Size... _ z!� <br /> Distance to naaresh Weli...f�r! ...a�.: -- --•_-•Foundation-_A PUF7'.._....Prap, Line._-.��.11.._..... <br /> REPAIR/ADDITION {Prey, Sanitation Permit ....._.._....................». "._.,_.,Dote....._....................._..-. .........,] <br /> Septic Tank (Specify Requirements)........ .....,.......... ......................»...-.............-_......••--•-•.•----------------- ......- ............... <br /> DisposalField I5pecify Requirements).................................._.._.... _.. . . ...._._...................................,-._--.---•--•---•---•---•-•---•-_._...._..,_ <br /> ---------------------------••...............-.......- • .................................................................. ......-.,.._,,.......-....... <br /> ................._..,.............. <br /> [Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this applicalion and that the work will be done in accardanca with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home ownef or licensed agents <br /> signoture eertifley 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 /> Signed . .Owner <br /> sy ..........................»...................Tiele...t <br /> [if other than owner} ' <br /> FOR DEPARTMENT U GNLY <br /> PPLICATION ACCEPTED BY .. 7X <br /> . ................DATE__. .. ._. .. __ . <br /> DIVISION OF LAND NUMBER .........,....... -----. ...DATE...-.........-....-.......».........�........ <br /> ADDITIONALCOMMENTS...........................................•............_............................................................................................ <br /> .....................•-------------.. ... ...._..... ... ... ..�..�._ j.. � ..._....-..._.�.__......................,..... ....... <br /> Final lnspaetion bYr ..... l ..L.... +_. Dale.......... _. <br /> EH 13 7i SAN JOAQ61N LOCAL HEALTH DISTRICT FU s'6""V-7/r+sM <br />