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FOR OFFICE USE: a APPLICATION FOR SANITATION PERMIT <br /> - � No.`-1_._7Y7__--S <br /> ------- ---------------- ---- ---- ---- 11 (Complete in Triplicate} Permit <br /> ------------------------------------------- Date issued ---------------- <br /> .i 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 <br /> described. This application is made in complian <br /> 0ce with County Ordinance No. 549 and existing►:Rules antl Regulations: <br /> JOB ADDRESS/LOCATION ._-- - r - F <br /> �------tJC�_H--------------- ----•----- --------CENSUS TR T -T. -- <br /> Owner's Name �=F�L( ��T I ----MEN_p ----A--------------- ------------------ ---Phone ---------------------------- <br /> Address 4f7 �--- II� U6.-- -------------• City <br /> 95 <br /> Gomme1cial ❑Trailer Cour, Phone ----------------------- <br /> pa, - <br /> LIl r icense '# -------- <br /> Contractor's Name dAN+'Q.g---- -- p_-�.� - - -�_�-� --- - ------ ------ <br /> U 34 ' <br /> <N%VResid�ence- Apartment ouse)ti ❑ i <br /> Installation will serve: ❑ <br /> Motel❑ Other - - - `� <br /> Number of living unity-J-- Number of bedrooms - --_--Garbage Grinder��� Lot Size __---- 6—vo <br /> ooms <br /> Water Supply: Public System andl name ------ -_-___ Private <br /> :x -- <br /> -- <br /> -�._ _ <br /> ii <br /> 1 #o a de6th of 3,feet:; Sand _ Si Cldy'-❑ Peat_❑ Sandy Loam .❑ C am ❑ M <br /> - ❑ . _ v <br /> Character o soi 1 Hardpan Adobe ,M Fill Material - ��_ If`yes,type ---------------------------- <br /> must <br /> -- --.-___-. - _-_ - <br /> J <br /> (Plot plan, showing size of lot,:'location of system in relation to wells, buildings, etc. must be placed on reverse side.} <br /> is tank or seep a pit permitted if public sewer is available within 200 NJ <br /> r <br /> 'Size- Xao-X--- �G --- ------ Liquid Depth -�-------- <br /> PACKAGE . } <br /> NEW INSTALLATlONg (No sept, <br /> JREATMENT Ca acct TIC TANK' m . -- , -�. Z_ <br /> SEP <br /> ' - P —FCR TMafie�ial_ ____ __ No. Compartments ---------------------- <br /> ----- <br /> y- - - TYpe <br /> ----- <br /> Distance to nearest: Well -------- _----------Foundation -/ -� --- Prop. Line --_�---------------- <br /> r • <br /> LEACHING LINE No. of Lines ___"2.—:-_____________ Length of each line--- --:- Total Length -•-------- <br /> __��---• <br /> lc <br /> k 'D' Box G!/YE_5 Type Filter Material4G ---Depth Filter, -Material ___ __________:___-------i______-•---- <br /> i <br /> Distancel to nearest: Well _. - =t�:__-�Foundation ----149-`�'-_- -__ Property Line -.- ---------....-- <br /> �/ �.._ <br /> SEEPAGE PIT {� Depth �pj�-.-___------ Diameter_--X--_�._._Number— ---------- Rock Filled Yes 2-- No ❑ <br /> Water Table Depth --------------------------------Rock Size �— <br /> ! !Ii Fouin dation Prop. Line ---- - <br /> j A Distance-to-nearest:-Well _____-M-4--�------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- -------------------------- Date ---------------------•------------1 <br /> g <br /> Septic Tank,(Specify Requirements) --------------------- <br /> VI 0 <br /> Disposal T_re1d {Specify s Requirements) ----------------------------------------------- <br /> ----------- -- ---------------------------------------------------------------------------------- <br /> 1 - - -------------------------- '------- <br /> -- ------------- <br /> --------------------------_ _ = } `��--- ----------------------------------------===----------------- :=, = _ <br /> (Draw existing and required addition on reverse-side) <br /> I hereby certify that I have pr p red'tii!`s application and-that-the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws,l and Rules and Regulations of the San Joaquin Local Health Districts Home owner or IiCe>t- <br /> sed agents s' ature certifies the t lowing: <br /> f I certify he erforman of the work for which this permit is issued, I shall not employ any .person in such manner <br /> as to be a subje t t Work an's Compensation laws of California." <br /> Signe --.-- - ---- ---------------------- -------------------------- Owner <br /> Y ------ - -------- ; <br /> - I { <br /> -I' ------------------------ R��GJ'n----. Title ---------------- ------' ----------------------- <br /> - (If other than ownt <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . 11--7-Ti- t '------------------------------------------=-- -------- DATE ----- �------------- <br /> BUILD.ING.. PERMIT_.ISSUED -------q------------_------------------- ---------------- --- - DATE = i— :�.:-___--:------------ <br /> ADDITIONALCOMMENTS =' --------------- -------------------------:-------------- ------------------------------------------------------------ ------------- <br /> t t€ . ---------- <br /> A. <br /> _ ----- <br /> ! ------•---- <br /> -------------- --- -- <br /> -- ---- ----- -- <br /> Final Inspectio - Date �� � '-� <br /> --- - ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M I "rte <br />