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FOR OFFICE USE: _ FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT � � �. <br /> 9 _ <br /> Permit No...._...�_.-_ ....-- <br /> - <br /> ------------------- ---- ................. <br /> (Complete in Triplicate) <br /> Date Issued4(-(7-.7 --- <br /> This Permit Expires 1 Year From Date-l,ssued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and•gual!the work herein described. <br /> egulla <br /> This application is-made in compliance with County Ordinance No. 549 and existing yRules and Rtions: „ <br /> ©!2D) CENSUS TRACT——............ + <br /> JOB ADDRESS/L CATIO <br /> ®�� .....Phone.......:...:.: • --------- <br /> Owner's Name . ul.. �f�`` /2,•--..:..----- -------- - ----------- <br /> Address .5 ..._ ...... City ... / <br /> . ..ne ip .. . <br /> Contractor's Name...... <br /> .. � ...- . .... . ---..License #.) 0.- -P ° -��--tl <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ s <br />_ Motel ❑ Other-........ - ---------------------- <br /> Number of living units:------ ... 1 t <br /> -Num. b r of ebedrooms...-. .....Garbage Grinder............Lot Size-------------- ------ <br /> f - •--- --- - /� �' �..�.�.- - '_. �______________ ___ Private ❑ <br /> Water Supply: Public System and name->....-.._ ..--. L "C <br /> -[ms's`- - -.. .. _ , <br /> Character of soil to a depth of.3 feet: Sand E] Silt ElClay El peat C] Sandy Loam 0 Clay Loam El 3 <br /> Hardpan ❑ Adobe❑ Fill Material.. ---- ----If yes, type...•---------------------- <br /> (PI <br /> .--------•----------- i <br /> (Plot plan, showing size of lot; location.of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> ' if public seweris a�dilable.wi•thin 200 feet,} <br /> NEW .INSTALLATION: (No septic tank or seepage pit permitted p .� s L.�. <br /> t <br /> PACKAGE TREATMENT [ } SEPTIC TANK [ } Size ----------------------------------- <br /> - =Liq t d Depth p..---- ------...- <br /> Capapity...._....-i -----Type:............ .... ...Material------- - ......._,_..:No. Compartments'. ....:.------- ----------, i <br /> Distance to nearest: Wel!............... .... ............ .........Foundation----- .Prop. Line <br /> LEACHING LINE [ } No. of Lines....------- -------------Length of each line----- ----- <br /> -------------- Total Length .:_ . <br /> ----- ----- ------ <br /> . <br /> 'D' Bosx_"_ Type Filter Material...----- ----- ...Depth Filter Material ............ ....... #._..._.....-_ 1' <br /> € r <br /> Dsstance.to nearest: Well:_"'__`.� °"" =77rFoundation: ---- --^--Proiler-tyrLine---- ----------4--- y <br /> SEEPAGE PIT [ } Depth..........I.Diameter--------------------Number------------------------------- Rock Filled Yes'❑ No❑ <br /> ..Rock Size...-_--�...._�...:.. � *�'--- --- <br /> Watet�.Table Depth ............... ..••-..,_ � <br /> } , <br /> on.__....... y :_......Prap.:Line:. .. i <br /> ista�ce to <br /> REPAIR ADDITION Pre�DSanitation Peramit#Well <br /> ._�-'�.��}-Z��' s rDatedati <br /> ----- <br /> -------- <br /> Septic Tank (Specify Re uirementsl-------€..... - ----- - <br /> Disposal Field (Specify Requirements).... .. <br /> 1- , �? ..._ ---- <br /> -. ...- - <br /> ----------------- ..................................._ --------------------------------- <br /> - _..,.:�.__.... _:._!_. i <br /> (Draw existing and required additi n on reverse side) <br /> w,e r <br /> I hereby certify that I have peepared this tbpplicatl6i, and that the work will be done in accordance with San Joaq in County i <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the followi g: F. ✓ i <br /> "I certify that in the perform, <br /> ante of the work fa -which 0s-T rmpeit is issued, I shall not employ any person in such manner as <br /> .r.� _ <br /> to become subject to Workman's Compensation laws of California." <br /> -----...Owner M <br /> Signed-............... <br /> NTitle ------ - <br /> '- ------- -------------- <br /> By <br /> (If other than owner) ' <br /> 1 DE TM T USt ,C)NLIf*` <br /> APPLICATION ACCEPTED BY e .{ - DATE._..L,�_-` �..`.71�.� ----- <br /> .-- - ----- --- ---- . <br /> ------ .. _ .•.. <br /> DIVISION OF LAND NUMBER'............:... ---- ................ ...-..-- ----- --..... DATE <br />` ADDITIOL COM EN <br /> TS ----- 1, <br /> .. .........--------- ------- -------------- <br /> ... ..---- - ....... <br /> _... <br /> -... <br /> � .. _... . - • ------ _... ..----- <br /> - <br /> l. f <br /> :. ...- Da <br /> - --------- <br /> Final InspecFiF&S 2167 <br /> �Y t <br /> • 7 REV. 7/76 3M <br /> I <br /> EH 13 2a SAN JOAQUIN LOCAL HEALTH DISTRICT <br />