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i6_ <br /> s - '-'f-Olt OFFICE USE: � � FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------ A­ <br /> (Complete in Triplicate). Permit No.,7Z _/OD <br /> F�}` Date Issued./4 / ----- <br /> ------------------- ------------- <br /> .•---------- --------------------- - -- --- -- 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 described. <br /> This application is made incompliance <br /> �with <br /> �County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT ._• > !_.-- --- �J�_� 1 CENSUS TRAC7 , - ... _ <br /> �'' �,�. -- ------------------------------------------------------------ Phone__71t�' � !� <br /> Owner's Name--•-_- _ --- .. <br /> Address--- f r��- . 1 L--_t, 1.� Ci �L /Y� A� i --- ----zi ,�� . ... <br /> // tY P <br /> Contractor's Name----- !_/4v .-_ C�_�_ L `--------- -_ License Z_ Phone_,_ <br /> Installation will serve: Residence Apartment House.0 Commercial ❑ Trailer Court,, Q <br /> Mgfkj `CD Other------------------------------------------------ <br /> Number of living units:.___ � __._Number of bedrooms----L�__Garbage rinder------------Lot Size__ ________ __ ___--------------------------_ .......... <br /> Water Supply: Public System and,name ---- --- ----- -------- ----------------= -- -- - - ------------------ -------- --- - -----------Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay❑ Peat 0 Sandy Loam ❑ Clay Loam Rr <br /> Hardpan [j Adobe❑ Fill Material------------If yes,type __ --------------------- <br /> (Plot plan, §howing size of lot, location of system in retation to we(s, buildings,etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank of `seer)d"ge i SPfi iT'j5 si ver i +art a Wit `in -feeT,j" ' <br /> PACKAGE TREATMENT [ ) SEPTIC TANK [ ] Size___ _ i __ _ --------------Eiquid Depth-- <br /> f ��--_,____ <br /> Capacity-/ �,� _ <br /> G <br /> Distance to nearest: Well-..- 4--� - --------_.-..-.-----Foundati n_J10--�_-- --------Prop. line_..D__i�.-- -- <br /> LEACHING LINE [ ) No. of Lines___ —4 _ ..._Length of each-line -__- �,t�--------,_____Total Length.:___, _�b -------------- <br /> _/ <br /> 'D' Box -t-----.-Type Filter Materia ..i� Xr/, Depth Fiber Mcitenal .. ,,r_ f�--- ----- <br /> Distance tp nearest:Well_:--------- ------Foundation.-- -- ----- Property tine--•-__ _ <br /> SEEPAGE PIT [. ] -Pg --- Q+ameter '------ ----Number----------_--------------- , mock Fired Yes [J ' No <br /> VaterTahle, Depth------------------- -----------------------------------Rock Size ; --__ -- <br /> 13ist `Go nearest: Well------------ <br /> -------------Foundation----------------- ---.Prop. Line--- ---• --- -------- <br /> ------- <br /> -- -- ---- <br /> REPAIR/ADE!TIQN(Prov. Sanitation P emit#------------------------------------------ ; <br /> ate - -- ) <br /> Septic Tankl(Specify Requirements)-------------------------------------------------------- -------- <br /> _--------- --------------------------- <br /> Disposal Fuld (Specify Requirements)--- ------ - -------- ----- / :_.._,- _. <br /> .. <br /> ......... ------- ------------- -- --------- ------------------- --------- ------ -------------­------ -- --- <br /> ..................Y________ ____.____------------------- ---------------------------------.--------------------------------------------------- ------------- ___ ... ________ <br /> r raw-existing arhd-f6gUffire"d odc'tmdh on-'re`v4r'%e si i <br /> herebycerki that I have ' <br /> , fy prepared:;this application and that he work will be dens its....+�ccordim -wilko. n Joaquin;County <br /> Ordinances,' State Laws; and Rules;and Regulations of the,San Joaquin Local r lralti.Ai ome owner or licensed agents <br /> signature certifies the following. + <br /> "I certify that in the performance ofithewvorlrfor w�lrieir this per+nrt i Issi<sed l shpt) not employ any personin such mapner.as <br /> to become object t W en's 4gtpensation laws of California." , t <br /> Signed------ oe..-- -----------------------------Owner <br /> i <br /> a <br /> By. . ---------t------- ---------------------------- - ------- ------------------------------ ....Title---------------------------------------- - - <br /> (if other than owner) <br /> FOR DEPN USE ONLY <br /> -. <br /> APPLICATION ACCEPTED BY------ <br /> = -DA E ��--- - <br /> DIVISION OF LAND NUMBER---- ---- ----- ----- -- --- - ----- ----- - ----------- -- �CSAfiE------------------ <br /> APPLICATION <br /> - ----- - <br /> AWTTICiNA'L CiSMMENT ---- ------------------------------------------------------------------------------ -- -- ----- -- --- ----- -: --- ------ <br /> ---------------------- -- - -------------•---------------------------_ .-` - <br /> ----------------------- --- ---------. . -------------------------------------------------------------------------- <br /> ----------- ----- - -- ----- - <br /> Final-,Inspection by:------------ ---- ----- --- ------ ------------ ---- --------------------------------------------------Dam=------ = ------- - ----- -------- -- <br /> EH t3 24 MS 21677 REV.7176" <br /> SAN JOAQUIN LOCAL HEALTH <br />