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✓ <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> Permit No._;7.,` <br /> -------- ------------------------ <br /> ------------ ------- - -- - (Complete in Triplicate) <br /> Date Issued_.k--,7-,..—7- <br /> This Permit Expires 1 Year From Date Issued <br /> is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein}described. <br /> Application ` <br /> This application is made in compliance with County Ordinance No 549 and existing RuI ss and Regulation: { <br /> I - ; <br /> _ - ------- -•"---- ------- <br /> TRACT . <br /> 13! <br /> - CENS Ph <br /> JOB- ADDRESS/LOCATIO = <br /> --"-- -------_ , <br /> * one--- ---------------------------------- <br /> Owner's <br /> ------- ---- --- - -- <br /> -----"---- "--- <br /> Owner's Name p <br /> Address--------- --- ---'�- - - - �.��--- - -- :- - " . -�*✓_ .-"-- City.-.- -- ., ,.. -------- --- ----P�--ne ---- ----"-- "---:-- --- ' <br /> � Zi <br /> "----------"------------ <br /> " License # - <br /> Contractor's Name--=- - `------ ----- <br /> Commercial t <br /> t <br /> - Coml- Trailer Cour '❑ <br /> Installation will.serve: Residen a [ Apartment House ❑ ❑ <br /> i Motel El : Other ------ -----" - - --------------- <br /> Number of living units:_____. _____-_Number of..bedrooms ___- Ga`�bage-Grinder ___-- Lot Size <br /> A-4--Gtf *'-`�y' <br /> = i -----=-= -. - ---"--_ . t <br /> Water supply: Public System 'and name---.°._------------- - ------ ---"-----=----------. <br /> f -Private <br /> t p p.Y' i i <br /> Character of soil to a depth of 3 feet: Sand Q Silt ❑ Clays[ Peat ❑ , Sandy Loam Clay Loam ❑ <br /> t Y tYP <br /> Hardpan [] Adobe❑ Fill Material-t T __lf_ es,-• e,' - -4- = <br /> (PltA <br /> ot plan, showing size of lot, location of,system in relation to wells,-.buildings_.etc. mustlbe placed on reverse side.] <br />` NEW INSTALLATION: '{No septic tank.41 r see ge pit permitted f public sewer is availa'tle "Ain 200 feet,} f <br /> .aV Y- f- vid <br /> Depth.---5� <br /> Li q <br /> PACKAGE TREATMENT ( ] ; SEPTIC-TAN•K -[ "Size------ --- <br /> . <br /> _,_No_,Compartments-__.:_. <br /> Capacity,::-_�a E' •Type,_ <br /> ' --= <br /> L Foundation.__,_._._ _Q* ---:Prop. Line_.__ <br /> Y . Distanceao nearest. Well.. "__- l <br /> 3 Len th of each line.- -- -- Total Length.__"�. -/ -------- <br /> LEACHING LINE [/'l No� of Lines --m ,' g /� ej <, - ; . <br /> D''Box .. ---- -Type Filter Material:-- "-C-=-'----/\--Depth Fi!#er.Mate[i � l,f \� <br /> t <br /> - � � ' ��- 1--,�-------- <br /> -.Foundation �Cd- �Pcoperty Line _-� .- - - - <br /> - <br /> !;/Distance to nearest Well_ .__ . Y - Y <br /> SEEPAGE PI _ `! t'� _�` Number -- -- --- k led Y No ❑ <br /> j q j �' R Roc Fil es: <br /> ` T I�1 .a` Dep is eter. <br /> th__ <br /> � . ,� <br /> m. <br /> b ize---� ------- <br /> . r ...: � 1 per- � -'---- oCk S - ��----- i`--�-! ----- <br /> ' ble:D /^ <br /> Writer Tp ePth -'------=------ - -- -� - - e <br /> R -- i., <br /> J_- __---____. <br /> j [�' -------Founda#ion. �� - Prop. Lin _*,== -}�`� a <br /> I i <br /> Distance to nearest:Well_-_--.._: ""---- <br /> ,. <br /> It <br /> isDate - --- <br /> -------"------------= ] <br /> j REPAIR/ADDITION-(Prev. Sanitation Permit#------------------------------ <br /> �✓. -- -- ---- --- -----" -"- ---- <br /> Septic Tank (Specify Requirements)_."- -------- ---= - :: -- <br /> 9 --------------- <br /> -------------------------------- <br /> i <br /> - <br /> Disposal Field,(Specify Requirements)_--"- �_.;---"- ---- -- ---- --:- ---_------ -------- ------- --------------- -'-- <br /> - - - ------------------------- <br /> -----------=---------------- <br /> --------------- - <br /> ------------------------------ <br /> G _____°_______'__ ------------- <br /> --------------- <br /> ----- <br /> _-- <br /> - - :----`------------" ., <br /> h t I here re aced this a lication and that the work <br /> on reverse side] <br /> i (Draw existing and required addi { <br /> � � � k will be done in accordance with San Joaquin County <br /> j I hereby certify fi e 1p P Pp <br /> Ordinances, State Laws; and Rules .and Regulations of the San Joaquin,Local Health District. Home owner or licensed agents <br /> t. <br /> signature certifies the following: <br /> l <br /> "I k for which this permit is issued, I shall not employ any person in such ma <br /> certify that in the perForrncnce'of'the wornner as <br /> to become subject to-,.Workman's p nsation laws of California." <br /> Signed t : -- Owner <br /> T. Title- <br /> By-1 <br /> 1 .rt_ <br /> (If other than owner) <br /> i <br /> FOR DEPARTME1 7 USE ONLY <br /> ' D = --------- -- <br /> ATE._. <br /> 7 <br /> APPLICATION ACCEPTED BY- --- ------- ----------------------- 4 <br /> DIVISION OF LAND NUMBER------ ----- <br /> -- --- <br /> -- ---- <br /> --- <br /> ---- DATE------- --------=--------------- -" <br /> ----------- ------------ -------- <br /> ADDITlONAL COMMENTS. - " ---------------------- <br /> -- ----- ------------ <br /> --- ----" <br /> ------------- -----•--- <br /> --------------------------- <br /> te �Da <br /> Final Inspection by: ------ <br /> L <br /> F&5 21677 REV. 7/7d 3M <br /> Ex 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> { <br />