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FOR OFFICE USE. FOR OFFICE USE: <br /> k/APPLICATION'FOR SANITATION PERMIT '7g <br /> .................................... ........ .[Complete in.-Triplicate) Permit No._/ <br /> ------------------------- ....... ........... <br /> Date Issued,/Z>'.z247:�EK <br /> ........ ............... ...... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health DistHct for a permit to construct and install the work herein described.' <br /> This.application is made in compliance with County Ordinance,No. 549 and existing,RulesGncl Regulations; <br /> ----------- ........ <br /> ACT.. <br /> JOB ADDRESS/1OCATION. -CENSUS TR. <br /> Owner's-N ........... . ................ . ..............Phone T- <br /> Addressl .0 T4 r.... -J��L0.00 b....... ...... ............. . .....city--- <br /> 4;T- ---TS' ------- <br /> !7�c:Q 0.0.. - <br /> -LA ' e #- Phone: <br /> Contra cto r's—Na ..........License ------- ..... -... <br /> c13 Q <br /> Installation will serve: Apoffrnent�klouse-E] Commercial ❑ Trailer Court F1 <br /> X71 <br /> Motel ❑ Other__...... J <br /> -------------------------I------- <br /> -1 30 ......... ..... .­G­arb-abe Grincler­,­­.....Aot Size........_-.. <br /> Number of living units-: -1—-7.Nu ber of bedrooms_' <br /> ----------Private <br /> p s ...... ------ -- <br /> Water Su pP I`y' 61�1 ic.Sy terWn - °-----•-----------------a'd 6 rh'e' ....... --------------- <br /> Character of soil to a depth of feet.,- Sand 0 �jjt�,] , ICI��.Ej ­%Peat�El Sandy Loom El Clay Loom E] <br /> Har a obe_o,'40'11.Materi6lt yes, type.............................. ... <br /> M�st'be placed on reverse side.) <br /> e I cati <br /> (Plot plan 11-of.'d ot'll 0�4t lih relation to wells, 6U'ild!n'gs`,-etc. <br /> I h?�Vmg,..s 1Z ,\".. . I I k � . . I \ I . 11 <br /> 't permitted public NEW INSTALLATION`, (N ic-tank; e' ,perm ed if 6lic sewer is available within 200 feet,]V . N I J <br /> -` <br /> Pr.geL'p1 %, IL � N . ...... <br /> T'. TIC '�K -9 <br /> PACKAGE T REATMIEN �A -X .......... .....Liquid Depth. <br /> C <br /> ........... <br /> 'a t r aP -0Q-C--t--------No. Compartments, <br /> Prop, Line..._. .75 <br /> We]I. ........Foundation_..__ <br /> Diitance to n t. <br /> LEACHING LINE 4"Of Ynes . . ....... a& I Line.... -----------.-. Total Length J-70--- - ------------------ <br /> ei�th Filter Material. <br /> F a: P <br /> xl-�. Ty e eri ........... ...------- <br /> da'tio Prperty ... <br /> istanc nearest: Well... 6Line. -(- ... <br /> -( <br /> I Rock Filled Ye Na 711t <br /> 2—, - . iameter... mber....2— ------ <br /> SEEPAGE PIT I 'X <br /> D epth'. <br /> 4 --------- ------- ....... <br /> Water Table D th----------- --------- ck-Size.- <br /> ------- 0 io --- ............Prop. Line--- - ----------- <br /> REPAIR <br /> ---- <br /> Distance to nearest: ell.. <br /> REPAIR*��D Sanitation Permit ---- - ------- ------------ ... .. .... <br /> ITION Prev. Sanitati <br /> .... <br /> Septic Tank (Specify Requirements)...... - ­- --- --------------- ----------- -- ...... ------------- <br /> ..p A <br /> ............... <br /> Disposal Field (Specify Requirements)...-- - ........ <br /> .................. ... ..... ........ ..... ............. ------------------ <br /> ------------------ <br /> r------------------------------------------------------ .................... -----. ------- ......... --------- ........... ........ ........ - <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done J1 accordance with Son Joaquin County <br /> d' <br /> Ordinances, State Laws, and Rules. and Regulations of the Sun Joaquin Local H"Ith.District. Home-owner or license agents <br /> signature certifies 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 Comp nsation. laws of Californ-ict." <br /> Signed-----..! - --�,��,r�: --- -� -- � � � - - <br /> BY <br /> igned------ <br /> BY............L,0� . ..... <br /> 7 ........ ...... <br /> 224' <br /> (if other than <br /> elk ONLY <br /> OR EPARTMXNT"'U <br /> APPLICATION ACCEPTED BY-------- -- ----- ..... .............L------------- ....:..-DATE ...... ... 2-6..? <br /> ......DATE-......­­................ 7------ --- <br /> DIVISIONJOIF LAND NUMBER_— ---------- --- .......... .. .... .......... <br /> ADDITIONAL COMMENTS............... ........ ........ ------------------- - ----------- - ......... ..... ......... <br /> ..........A....... ­ ...... - --- -- --- - <br /> ---- <br /> - <br /> -----------------­­--------- ­- ......­ ..... .... <br /> ---------------------- ........ .......... ............... <br /> .. ...... .......... ............... <br /> -------------------- ----------- ---- --- <br /> .......... - --- ----- ---- <br /> ------------------- <br /> ­ ------------ ---- -- --------- --------- - ------- <br /> ------------- ............ -------------------- -------- - ............ --------- ------- k <br /> ..........­ ----------- <br /> ------Date. .....A�- - <br /> Final Inspeciion by:...... ........... -------- .......... -------------- ----- <br /> 42 7. E4 F&S 21677 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN MCAL HEALTH DISTRICT` <br />