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RFOR'OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> ---------- ---------------------------------- <br /> (Complete in Triplicate) Permit No..__�--1-1--. `5 -- J <br /> ---------------------- ---------------------------------- <br /> Date Issued-_,//=.y `�� <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 in compliance with County Ordinance No.549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION._ . --SrW'_-_-- _.CENSUS TRACT------- ------- ----- <br /> � . <br /> Owner'_s Name- �J��.C�- :%- - --� -I��-- -------------------------- ------ -- e----------------------------------Phonle-- ------- - ---- --- -------' <br /> Address--------------- ---- ------ ---------------------------------.-_._._..--------------.-------`------<-------City..-- --- �� Z------ --- ---- --- ----Zip------------------------------ <br /> Contractor's Name_ - jR`�f� jJl t ° 1 <br /> J 6 <br /> Installation.will serve: ?s Residence Apartment House ❑ Commercial ❑ Trailer'Court ❑ <br /> Motel F] Other -------------------- ----------------- <br /> Number of living units:_ ______:brber of bedrooms:,. :____Garbage Grinder__X-_._-Lot Size------- ____________________________________________ <br /> t 1 1 [ ! <br /> Water Supply: Public System and"name------------------ <br /> - ---.-- . _ - ---- --------------------- -------------------------------- - ------Private <br /> --•+ ' "`Hardpan i 'Fill Material ____.__.If yes, , -Adob�Character of soil a depth of3feet: Sand Silt Clay Peat <br /> ❑ andyLoam- <br /> Clay Loam ❑ <br /> (Plot 461 n^showing, ize of lot, IocatioA of system in relation to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: '(No'septic tank or seepage .pit ,permifted if public sewer is available within 200 feet) { <br /> PACKAGET.REATMENT 1 SEP —TICSize___/_-+- <br /> ----------------------------------i----Liquid Depth.__ r� _ ____ <br /> � Ca acit _T egJF) Jr Material.__l efr` Com artments.__.__�_____ ___----------- <br /> ------------- <br /> __________ <br /> i P Y' s v Y P P <br /> 070- - __ .-;---._,,.._,,--:Foundation- ...Pro �# I <br /> ` Distance to nearest: We1L_._.�/. - _-___,_,__. p. Line__________ <br /> LEACHING LINE, [ ] No of L1es_.__i„5---------------------tength of a ch line(_ v------..............Total <br /> . .._ -- Length <br /> __._____ <br /> D' Box J�! -Type Filter Material- <br /> MaterialDe Filter Material--- - ' <br /> ----------- <br /> -.Distance,to nearest: Wel ------- - undatit ___ --Property Lin <br /> e.___ cam____ ' <br /> [ j, P l <br /> SEEPAGE PIT De th, -_- ___._ "_D,ameter__.____ .._______._N ber__ _,________ " Rock Filled Yes❑ No C] <br /> 1 1 <br /> E t Water Tcibla•Depf l.-�; - ----= --rRock Size----------------------------- ) <br /> i <br /> //�3 Distance to near. •yW ll------ _-- -- -'---:-'-- - '-- -;-- Foundation--------------------------Prop. Line----------------'_---------- <br /> - <br /> �... !-:Date } <br /> 4 ( r r.. ' ------------------ - ------- ------ <br /> REPAIR/ADDITION Prev,=:SanitationiPerm't' t <br /> Sepiic�Tank {Specify Requirements)------ =-`''' ' i----=--=--- ---------------------- --------------- --- ------------ - <br /> Disposal Field (Specify Requirements)=-- ----- ----' ----- --------------- ----- ------------------------------------ <br /> ---------- <br /> ---------------------- - -------- <br /> d " --------- ----= -------------------- - <br /> - --------------------------------------- <br /> -- ------ - ----- - _ . ---------------------------- <br /> -- <br /> . <br /> l F <br /> i --------------------------- -- - <br /> {r (Draw existi -c nd;requieed addition on reverse side) <br /> I hereby certify that I have r�epare This applic io -and that-the .work,, will-be done in accordance with San Joaquin;County <br /> Ordinarices,.4tate-Lawsierl `R' s� and_Regulatibns of the ',San,Joaquin-Local-.Health-District,_Home owner_or..licensed'agents <br /> signature certifies the followjng: # ' <br /> "I certiN that" in the pet formance of the work for which this permit is issued, 1 shall not employ'any person in such manner gas ] <br /> to become subject to Workman's Compensprmnllain s of .California.'.' <br /> Signed ' - F: } ., -: -owner <br /> --- <br /> ke ! <br /> BY _ 1 �'-` Title- - - -------------------- ----' - <br /> # "~�(If other than''owrier) <br /> FO DEPA -ENT USEONLY A <br /> APPLICATION ACCEPTED BY- - -- .-DATE.-- --- - } ' <br /> DIVISION OF LAND NUMBER--------------1- --------------------------------s. <br /> ----- -------------------=------------- ---------DATE.----------.------------------------ --------- <br /> ADDITIONAL COMMENTS = - - --- ---- -------------------------------) ---- ---- <br /> I <br /> - - - <br /> - --- -- — --- ----- <br /> l _ � . t'•—. I . <br /> ----------- ------- ------- <br /> n '! <br /> i <br /> Final Inspection b -'" ., ..r : - _ ------Date-------------- ----- -----•_------------- --- <br /> - 5 21677 REV, 7/76 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT r <br />