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FOR OFFICE USE: FOR OFFICE USE: <br /> r ApniCATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit <br /> Date Issued.,.-1,.3_-Z <br /> ------------------------------------------- ------_______ This Permit Expires 1 Year From Date Issued <br /> T <br /> l <br /> f <br /> Application'is herekiy made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with C my Ordinance No. 549 aryl Tkisting Riles-teaRegulations: <br /> t'. -I -- <br /> JOB ADDRE55/LOCATION-----rZc_ -.. -..-- - . tl ------------ -CENSUS TRACT.--..5.W,, t ......... <br /> Owner's Name-- <br /> h - -- ------- -- ----- -- ---- <br /> - - - -t-- - =- �-- - - - ----- -- ---j - hone ----------------- ------- <br /> Address <br /> ---- ------ --- -----------------------C i ty- ep-4:7. ---------------zip---9-n---33'� <br /> Contractor's Name--- _L. -&-. F <br /> l.T--'t-f---- - tt a--� -I:^�--. C-._License #_;ZP __p_ -:6.-Phone_-8' y-'/ <br /> Installation will serve: Residence Apartmen House.❑ _Commercial ❑ Trail r Co rt E]ElMot I Ot - <br /> - ---------- --- ---- ---------------- <br /> Number of living units------- ------ - ber of be rooms.-.X,,__�.k�age Grinder____.______Lot Size 7 _ _-V.__ -----_.-___--:_____._. <br /> Water Su l Public System and ame--.---___.__ *+= r <br /> pp Y= Y O�-.� ----------------------------------------- --- - --- ----------------Private /Qr <br /> Character of soil to a depth of 3 f t: Sand Silt ( = y ❑ Peau Sandy Loam C ay Loam ❑ <br /> K: <br /> " Hardpan Adobe Fill M' erial._________If yes, type--------------------------- <br /> (Plot <br /> -- --------(Plot plan, showing size of to , tion of systen in rel in to wells buildings, etc. must be lace on reverse side.] <br /> NEW INSTALLATION: (Nos c tank or se page p t d if pL4c sewer is ova la le within 200 feet,] <br /> PACKAGE TRE�TMENT�[-] )E IC TANK [ Size---A�.D_.&---- ....0; _gib _________ -Liquid Depth --- <br /> p N6 Com artments LCapaClty.4.66 ------ <br /> O <br /> f Dis o nearest: W Foundation._ _ <br /> ----- -----.Prop. Line__ _ .. <br /> ----------- <br /> L ( ] Na. f Li es.----- ' ' vgth each line...------------ otal ngth ---� X ��', <br /> Y <br /> I a'z <br /> � u fid' 'D' B�. .---.-..Type Fil r Mattrtal,2." :Depth Filter Ma e <br /> Distance to nearest: W II__4/la9? ----- Co !�! f � Pro erty Line-..--!P7 -44.4------------ - <br /> SEEPAGE PIT ( ] Depth -- -----Diame r..--.. ------- unwb ------------------- �_ _^ j Rock Filled Yes ❑ No ❑ <br /> Water T ble Depth-L-- ------- I ------- ` r'-----------------.Rock Size- i - ------- <br /> -- ------------------------------ <br /> Distance o nearest: W II --- ;- ---------------Foundation.-- . - --.Prop. LinerV..-----._------ --_-- <br /> 9 # ; <br /> :,REPAIR/ADDITION (Prev. Sanitation Permit#_.-. -__ �-_ R_- - _ . Da#e _ 0 <br /> Septic Tank {Specify Requirement ------ ------ ------ I ------- ---------------------------------- - ---- <br /> Disposal Field (Specify Requirem nts)---------------- ----- ------------------------------- - <br /> r , # s � <br /> i i -,'I% - - --- - - --- <br /> r <br /> (Draw a is and requi&ibadd`ition on reverse side) <br /> I hereby certify that I have prepared this a to a ork will be done .in accordance with San Joaquin. County <br /> Ordinances, State Laws, and Rules and Reg s an ea District. Home owner or licensed agents <br /> signature certifies the following: -3411 ) G <br /> "I certify that in the performance of the work fpr h this �err�i►`t '��ssis", I Ir�oT ploy any person in such manner as <br /> to become subject to Workman's Compensat T of Cali ornia.., <br /> Signed- A-13-4 - - ------ -1CPWnia <br /> BY--------------------- -- -------- -------------------- -- <br /> -- ---- - �. ------- - ---- ---- --- ---------------- <br /> (If other than owner[ <br /> OR PARTME USE NLY <br /> 12 APPLICATION,.ACCEPTED BY--------- ---DA 1 -- ----------------------- <br /> DIVISIONOF LAND NUMBER-------------- -- ---- - -- -------- --------------- --------- - ``----- ---- -------- ---.DA -------- ------------------- -- ---- --------- <br /> - -- - <br /> ADDITION COMMENTS.' _ _ ---XI <br /> y <br /> --- ------------- ---- _ ------- --- <br /> ------- �� �� -Z '- <br /> ---------------------- <br /> - �--------- ----------- <br /> ----------------------- a t = <br /> �re <br /> ---------- -- ---c�-�y------------------ <br /> Final Inspection by:----- ------- ------------------- ------- ------ � <br /> EFI 13 2- SAN JOAQUIN LOCAL HEALTH DISTRICT Fa$-21677 REV. 7/76 3M t <br />