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Mgt P� FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit <br /> �` <br /> ---- =---- ----------------------- - <br /> ----�-4-- ��"--� (Complete in Triplicate) <br /> Date Issued..__=-Z T <br /> --------------------------- ------------- <br /> f 4� This Permit Expires 1 Year From Date Issued <br /> ---- t ---------- <br /> d install the a permit to <br /> Application is hereby made to the San Joaquin LocalHealth District <br /> for and exist ng Rules and Regulations: work herein describ <br /> p y 1 <br /> This application is made in compliance with County _ s <br /> i } �SC�Gfl.-- -- CENSUS TRACT-------------------------------- <br /> '4-.: <br /> ----- ------ ------ - <br /> JOB ADDRESS/LOCATION-_.'- ,-�-. - r / Phone0..?f,.30-R- -"--- i <br /> � f} !//ari! ,RC1 - --- -- -------------------------------. <br /> --- . ---- - - <br /> Owner's Name �/- L � - - -- Zip--- <br /> ------------- <br /> . . <br /> .�.t � E-- � --�E's City. - <br /> Addess_ -r ------- <br /> r - <br /> -- --- =--- Pane + <br /> . z <br /> ------- <br /> ----- icense <br /> Contractdr_s_Name- �- Comercial Trailer Court El <br /> Installation will serve: Residence Apartment House QmE] <br /> M6teI 0 g Other:::. - <br /> i -- <br /> I <br /> 4 <br /> . .^ arbage Grinder. -- _" ---Lot Size -- "-- ------�- - -- -- <br /> Numbe�of livin units:..____ """"-Numbe o G private <br /> 9 . - <br /> I l <br /> Water Supply: Public System and name__ ---.---. t _., a <br /> Silt❑ Clcr�ya❑; Peat ❑ Sandy Loam Clay Loam ❑ <br /> Character of soil to a depth of Meet: rid ❑ e ; --- <br /> t. Hardpan<],; Adobe ❑.. Fill Mteci, - .° . if Yes, typ = " I <br /> of lot location of system in reE'ation to wells, buildings,'•etc._must be placed on reverse side.] <br /> M-Y R size <br /> :. <br /> I (Plot pfcii;•showing size„ F { <br /> r sem epage pit permitted if p �i s er is available within 240 feet,f t <br /> NNEW 1NSTALLATIOIV r Na setic ,aiak or I--- <br /> 6V �/a�i - ----- --Liquid De th. ._ -.. ._ <br /> Size_ <br /> PACKAC E= TREATMENT' [`] `SEPi,IC 7A�K r� /- o, Compartments--------- <br />• - Materidl �t--- i / <br /> - <br /> j Foundation. . -------- ---- <br /> _ Prop. Line._ <br /> rr 'Distanceito nearest: Well.'..... G, - <br /> [ N'o of Lines � � Length Jaf each lin <br /> Tot Length <br /> ' <br /> LEACHING LINE � �" <br /> ' Z De t Fi er Material----- -- --- ----� <br /> tiD' Box. --,--TYPe Filter Mater�ic(1���.. � ►- <br /> Q rj' - Pr'o erty Line <br /> m�. - .. �...r .--,�- Q ._Foundation/-- p <br /> 5 . <br /> ' Distance to nearest: II Yes ❑ No F1 <br /> N --------- <br /> :Distance <br /> --- -- ------------------- <br /> SEEPAGE <br /> Fi <br /> Nu t� <br /> Rock � ed <br /> SEEPAGE PIT E��2�Depth--------------- Diameter r / f 3 ----- ------------- <br /> Q Rock Size /-------_.---=------- L <br /> �/ <br /> Table'.Dep#h < f1 1` <br /> i ---------------------- <br /> ------------- <br /> -Sanitation <br /> --Foundation._. Prop. fine---------------------------- <br /> water' ''Distance'to nearest: Well_°_------------------------- <br /> . � Date ------ -------- <br /> REPAIR/ADDITION <br /> ---- --- �- ------ ------ -- <br /> REPAIR/ADDITION (Prev. Saniion Permit# = = ---------------- <br /> - ---- <br /> s E i <br /> '. Septic Tank (Specify Requirements)--- = - - <br /> I �a-- ------ --------------- -- - <br /> ( -) - <br /> Disposal Field (Specify Requirement)} "------ -- - --------------------------- <br /> ----- - -- - -------------------- -----------_ <br /> t -- - ---------- - -- -- -- ----------- ----_- <br /> -------------- ---- <br /> I • - ------ ------=----- = - <br /> t ------------- -. <br /> ------------------------ -------------------- ----- 'd <br /> (Draw existingand required addition on reverse side) <br /> will <br /> d6ne-in accordance with Sn <br /> I hereby certify that I have prepared this application and that the'boa uinLocaI Health Districtt. Hom owneCound orJlicensed agents <br /> i Ordinances, State Laws, and Rules and Regulations of the. an q <br /> signature certifies the follows g: erson in such manner as <br /> i "I certify that in the per'foimance of the work for which this permit is issued, I shall not employ any p TJt <br /> 1 'subject fio.Workman's. . m ensation aws .o California." <br /> P f� <br /> to becomeC -------Owner ... <br /> �Signed <br /> ------ ---� -- / ---- -- ----- <br /> t <br /> - i -Title <br /> -------------------- <br /> BY -=---------- ----------------------- <br /> (If other than owner) I <br /> FO PARTMENT USE ONLY <br /> li DATE..__. -��- .-�.7L <br /> APPLICATION ACCEPTED BY-' DATE.: <br /> --- <br /> - <br /> DIVISION OF LAND NUMBER--- ---------- -----_ -_ .... ... <br /> -- ------------------ <br /> 1COMMENTS " <br /> ADDITIONAL --- ------------------ --------- ---- -q --=--: <br /> ------ ------ ;# --------- <br /> ---- <br /> --- :: <br /> i ------- ------ --- - .. ------------------------------- <br /> --'----- <br /> Final Inspection by::------- -- - -- <br /> - ---- --- 2 EV,7/76 3` <br /> W 13 24 SAN J QUIN LOCAL HEALTH DISTRICT - ` <br />