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• FOR OFFICE USE: I FOR OFFICE USE: <br /> ;3 O APPLICATION FOR SANITATION PERMIT <br /> Permit No29:7: 43./---- <br /> (Complete in Triplicate). - - - <br /> - <br /> .......... ------ Date Issued.l� 17- <br /> �I This Permit Expires 1 Year From Date Issued . <br /> Application is hereby made to.the 'S'an Joaquin Local Health District for a perto construct and install the work herein described. <br /> This application is made in.complince with County Ordinance Na.,.549 and.existing Rules and`Regulations: <br /> k .:CENSUS TRACT----- ---•- -- ----- <br /> .JOB ADDRESS/LOCATION......0�.l 3-3_:S'Q...�� <br /> Owner's Name._,; IG! VPSSfZ*IE�Z - ---- P s <br /> hone <br /> ........ <br /> Address--- G �. ...�Q,: L. �Q !�L:7�a-- ----- -------- . . .. city.:_ Ph <br /> �3 o ne.... .. 9- <br /> /�I X2/7 s/ af- spill-- -----.. _._.;.... .-- _ . :License #.. <br /> 6 �e7 <br /> Contractors <br /> Installation will-serve: Re1sidence� Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> A. Motel ❑ Other-: : --------- ---------------------- <br /> X _ . . <br /> Number " living units:,..._.1........N'umber of bedrooms..- -- Garbage Grinder............Lot Size-___..-- �� <br /> I7 ----------- <br /> Water <br /> -- Pr1 ate ❑ r <br /> Water Supply: Public System and Arne �� . <br /> .III' Peat Sand Loam - Clay Loafn-D <br /> Character of soil to a depth of 3, feet: Sand ❑ Silt❑ Clay ❑ ❑ Y ❑ <br /> Hardpan Adobe Fill Material.. . - -._.If yes, type- <br /> F <br /> (Plot plan, showing size of lot,.loc;'tion of system in relation to well's, buildings, etc. must be placed on reverse side.] <br /> NEW INSTALLATION: (No.-septic tank or seepage pit permitted if Public sewer is available-within 200-feet,) <br /> b�- 'quid Depth'._- <br /> PACKAGE TREATMENT ( ] SEPTIC TANK [kI Size...._.... _.. - - L' - <br /> .� T <br /> .....Mpterial-------- --------- -------No. Compartments.- -------- •------- <br /> i CapacityA----- ---- ---------Type <br /> Pro Line......- ----------- <br /> Distance <br /> ------- �3 <br /> Distance to nearest: Well:"`------=,---- Foundation......... . ......... p <br /> LEACHING LINE [ ] No. of Lines -------- =----Length of each line .---._....--------- ......... ... <br /> .Total Length .. ....: .---:---- Q <br /> II`` f Depth Filter•Materiah_ . ------------- --- ------ - --- <br /> 'D' Box.., ... Type Filter Material— .... .... a -. -,..... , " -"o"'� <br /> .,- <br /> �- <br /> 4. -----Foundation---_------------------ <br /> Rock <br /> -- --------- -- Property <br /> Distance o nearest: WE:II_� -.:.. <br />�- ock t Ye N <br /> SEEPAGE PIT [ ] Depth---..�...........Diameter------ -- ... Number----: --------------------- <br /> Water <br /> -_-- ----- <br /> R Filled s ❑ o <br /> Water Table Depth.-- Rock Size_......... ...... <br /> I -..-.Prop, Line..-...... <br /> Distance: o nearest: Well------------------ <br /> --- ; Foundation._.-_---------...--- <br /> - -- ...--=.... ----- ---------� <br /> REPAIR/ADDITION [Prev. San'statiL Permit#........... ....._.-.__..... Date - -------- <br /> I <br /> Septic Tank (Specify Requirements]..: • ---.................. --�---- .....,,--- ...---------•- - , <br /> Ih �E --------- ----- <br /> Disposal Field (Specify Requirements):-.- ------------- <br /> 3...?�. P� <br /> J -------- . ... ...................... <br /> E611. <br /> ......... <br /> i -------- ....:..... ..... I ---------._.....:................ ------ <br /> (Draw existing and required ddition on reverse side) <br /> r <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�Regulation-_-- f*the San Joaquin Local Health District. Home owner or l <br /> icensed agents <br /> signature certifies the following: <br /> "! certify that in the,performance of the work for whiS this permit is issuedr'1 shall not employ any person in such manner as <br /> - -- �°- <br /> to become subject to Workman's Compensation`iaw`s>f Califor-iiia."_ <br /> $Signed------ -------k............. .. Owner <br /> {� <br /> M e -­ <br /> Title_ S <br /> FJ <br /> (lf other hon owner) <br /> j. FOR., EPART E T',USE 0 NI Y, <br /> l1 7._.. <br /> Q <br /> ------ DATE .... <br /> APPLICATION ACCEPTED BY.- _ -_. . .- <br /> ---- --..._..DATE ..... ..................... . .... ------ -� <br /> I DIVISION OF LAND NUMBER.-..:I......... .......... ..... <br /> - ---------- ----- --------------- <br /> ADDITIONAL COMMENTS... ---- '- -- --- ­- ...._. -- - - -- ...... <br /> .. . .. .. ... ...... <br /> k -.-.- --- p ._-- . .................... a - --- - <br /> 9 moi? ------ -• -- --- -- .. <br /> . ....- .- --- .. .... - <br /> - Date ... --- <br /> Final Inspection b rss 216 V. 7/76 3M <br /> Y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> EHA3 24 .+ a ��� _.._ ••moi <br />