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FFOR OFFICE USE: <br /> OR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �. <br /> ' ----------------------- -------- Permit No`77_� � <br /> (Complete in Triplicate) <br /> --- ----------------------------------- --------- - <br /> Date Issued__]_� __%3_77_ � <br /> ---------------------------------------------- I This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local-HealthDistrict for.;'a permit to construct and install''the work herein described. <br /> rt-'._...-: <br /> This application is made in compliance Wirth. County Ordina`nce_No."549 and"existing Rules and Regulations: <br /> Q <br /> JOADDRESS/LOCATION.__ ,_ ._C __ sr. - - `' .--- -«' '__-- CENSUS TRACT._ ___ <br /> t .. 04- - - ---- - ---.Phone-- � ; ------- <br /> B <br /> Owner's Name-------- --. + '- -.- � x �+"� <br /> Address--------------- + � r. ..� €`Jo.re __ €�_.. City �'P <br /> F ' <br /> Contractor s Name- +-:: �--t-- _ _:�_� .°--'_ --------_-- -f-- ------------------License # + ---------Phoned_d --- <br /> Installation will serve:, Residence X Apartment House.7] ;Commercial ❑ Trailer Court ❑ d <br /> ( f ..}: Motel_[],. Ot• r �_.J -- - ------- <br /> um <br /> --=- i' <br /> Number of living units:._ _ Numbei of bedrooms____________Garbage Grinder_.______ I_Lot 5i e _ ______., _-. <br /> n 4 L p '' lad - .Private F <br /> Water Supply: Public System and name_-�---------- -.:---,�,--,_--- - _-'-.:------ ' ,---�- -- - • ... ❑ <br /> Character of soil to a depth of 3 feet:'t Sand ❑ Silt:❑ tClay ❑ Peat _ Sandy Loa4m ❑ Clay l_oam2�, <br /> - Hardpan EIS Adobe .Fill IV/tciteria!_..____..._If "❑_es, type ( <br /> - <br /> (Plot plan, showing size of lot, location of system in relation to.we(Is, buildings,.etc:"!must be placed on reverse side.) <br /> PACKAGETREATMENT-SIO . [(No"septic tank•or seepage pit •permitted if public sewer is available within 200 feet,) <br /> SEP'TIC I�TAN1K[ ]" t­ a c � - <br /> `� -,___ -F, `i'k L,iqIF�ui1d Depth <br /> th--------- <br /> 17P � <br /> 4'_i_:`_"____-- __ <br /> _CNo. CamPartments t` + - ---- - - <br /> S <br /> S' <br /> � <br /> { _ ----f-:- -- ype___._ ----- ___-- '_ <br /> ___ Foundation_ <br /> Distance to nearest: Well_:______________ ____ _ _..__� <br /> LEACHING LINE [ ] No.. of Lines--____ _____ Length of.each_l•ina s Total Length . ' ' $ <br /> ___ Depth Filter Material ._____ __.___ <br /> `D' Box _'_..Type Filter Material--,--, p _. t ----------------------- , <br /> } <br /> Distanceto nearesfc Wel!_ _.____:__ ---- __ *Fou'ricldtion__.i__.__ _ .Proper Line .__. <br /> SEEPAGE PIT [ ] Depth_ _ Diameter.___ o -- r Number s ' Rock Filled Yes ❑ No ❑ <br /> • water Table-Depth._ ____ -- .Rock•5ize-------------------------------------------------- <br /> Distance'to nearest`Well --- �: Foundation----=-----------__-- '_.Prop. Line-- -----------;--- <br /> i <br /> REPAIR/ADDITION-(Prev. Sanitptron Permit# -� -- Date _ ______________ ) <br /> ------------ <br /> Septic Tank [Specify Requirements} :, _t� '"r_ fe-rt - <br /> x.. ;; r <br /> Disposal Field (Specify Re uirements) Z ` ' # 'f C'lY ' ----�-�� <br /> ° .------.-------------------- <br /> --------------- ------ --------------------------------- ------------ --- -- ..------------- --- - - -- ---------------------------- ----- ---------- ----- <br /> 'ecl = ,-.e idef <br /> [ (D#aw existing and required addition'on reverse s' { <br /> I hereby certify that I have prepared'.#his' application and that,the work will be don 'n accordance-with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regu145g, <br /> �at ns- he, San J aquin-Local Health District. Home owner or licensed agents <br /> signature certifies the following: j'' r j <br /> "1 certify that iri'the pial rmdrice'of the.work fo`r which this permit is issued, :I shall not employ dny person in such manner as <br /> to beco sub' ct to, " F <br /> i rkman s Compensationlaws of California. Y <br /> www• `l <br /> Signed_ rE'Y� _�#s ' �Qwner <br /> e <br /> By-! t.• �.-- -- Title Y '� -- -- --- ----- i <br /> I {If other than owns } <br /> FOR DEPARTMENT USE ONLY <br /> ,,9,�- '- • . _ .�_ __ _.,------T- DATE." ---- � 7 _- = <br /> APPLICATION ACCEPTED BY---------------------- ---- --- -- - - - --- ---- ---- - - - --- - -- ------ <br /> DIVISION OF LAND NUMBER'____ _... ` ' <br /> - TE-- _..- <br /> ---- DA <br /> AD TIONAL COMTS ---------------- - - ------- - - ----------- ----------------- <br /> 77- <br /> ------ <br /> ------ <br /> r <br /> f f <br /> -- -- --- . ----- - <br /> A/1- <br /> ----------------------------f --------------------------------- <br /> -------------------- <br /> .___.___________- - -_ ---------------- <br /> ---------- <br /> R <br /> r _ <br /> Final Ins Inspection, =- � _ == - .` - =Date ---- <br /> p by__-_t­_-.--- --- <br /> EH 13 24 T SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21177/76 inn <br /> ii "i <br />