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✓ FOR OFFICE USE: <br /> FOR OFFICE USE: -SANITATION FOR PERMIT <br /> i Permit No.� �1a9 <br /> ----------- (Complete in Triplicate) <br /> 1 Date Is <br /> This Permit Expires I.Year From Date Issued <br /> ----------------- -------------- --- ,F. <br /> Application is hereby made to the San <br /> ceJwi h CountylOrdi�ntanDesNo. 549 and existing Rules and Regulations:trict for a permit to construct and install the work herein described. <br /> This application�. is made in com J0QDRESS/tOCATIOIV- _ ho ------------------------------------- <br /> __AOwner's Name---- - ------- ------- <br /> - ,, <br /> I ° � _ Cit, <br /> -Zip_ <br /> Address_ - ' q - <br /> - Y t� Q <br /> s Nam �' P-cdr� - License # _1:� Phone._ �� <br /> Contractor �� = d <br /> +�^ Trailer Court ' <br /> Installation will serve: Residence Apartment House.❑# Commercial ❑ N❑ R <br /> ' tel [t — Other <br /> . { --- ---------------- --- ------ <br /> 4 _ ".LotSize_ <br /> . <br /> Number of living units----- ---==---Number.of,b rooms__ _ <br /> iMl Isi Gaiba' e.Grinder� i ;--Private <br /> F <br /> pp.y- T4s <br /> Water Su l Public System Band�ndme------- <br /> i Silt Ciay ❑ Peat ❑ Sandy Loam;❑ Clay Loam Q <br /> Character of soil to a depth of:3 feet: Sand ❑ Q. , <br /> Adobe Fill Material_. If yes, type __1\�_.-- - '-� '" <br /> ' Hard`pan❑ t, <br /> t <br /> ' buildings, etc. must be placed on reverse side.} <br /> F [Plot plan, showing size of lot location of system Oh relation !^�el�js, <br /> ,_._ <br /> '200 feet,M <br /> Size-( ith i n <br /> NEW INSTALLATION •w ,'(IVo septic tank'or seepage pit permute , i public sewer is available w � <br /> f u+d De th, '----------------- <br /> LihSEPTIC TANK ��,� - _ -; .i '.�-__ _, ' t I p <br /> PACKAGE TREATMENT""[ J ` r y�, . - •, k <br /> II! sMatariaf_ .._No. Compartments_-_ -- <br /> Ca acitG �Le� wTY.P_. r e <br /> p tlM I e" ! <br /> ,Distance to nearest: <br /> Foundation_._�!i1 :F _.+_:Prop: Line <br /> �N I ' .. � ---.Total Length.- <br /> g <br /> �. <br /> LEACHING LINE`" � � � ± ..Length o/hv�-'" line a gg - <br /> Na. f Lines----- - E <br /> D' Bx-_:-_____Type Filter Material__ 4__vDepth Filter MateriaL_ _� `- =-- `r. <br /> } s ; - <br /> Foundat oin`- = P,roperty lin <br /> Dista�nce to nearest: Well_-_—_ - �D <br /> r rRock Filled Yes N ► <br /> � -------- . -Number __. qr e- <br /> !.� <br /> SEEPAGE PIT Dep�- t- -Diameter",-- <br /> } Depth , <br /> Rock Size-- --- --- - <br /> Water Table Dep. - - � - _ _ ..... 'o?�-�---�•-��r <br /> ` `Prop. Line-i <br /> t t Distance to nearest: We1L/.�Q--=--- Foundation ,� <br /> t t ` <br /> ir- ?- .Date-_ --- -------} <br /> REPAIR/ADDITION (Prev. Sanitation Pf rmi. #_"'------ ---=- -- -=------ i <br /> 1(I --------------- -- -- - ----- ----------- --------- <br /> Septic Tank (Specify.Requirements)-_1--------- - - -- -- --- -------- <br /> : --- ------ <br /> ----------- � <br /> Disposal Field (Specify Requirements)L-_-------------------- -------------- r <br /> Ii ---- ---- 1 <br /> 11 <br /> ! - r <br /> Ih '_--__'--__-_--�- -7-- <br /> I - <br /> ----------- <br /> --------------------------- _ It <br /> (Draw existing and required addition on reverse side) A; <br /> It hereby-certify.that,I have prepared this application and that the•work will be done^in accordance, with San `Joaquin Cou <br /> Ordinances, State Laws, a:6 d Rules and Regulations of.the;Soni Joaquin Local Health District. Home owner or,lice sed agem� <br /> signature certifies The follo V�ng: person it such manner as\ <br /> "l certify that in the erformance of the work for which this perrrii't is issued, l shall not employ any <br /> P <br /> : <br /> to became subject to. Workman's Compensation'laws of California. G4nL,,` <br /> t canerG4 Sa. 4{acickc;�`i U i �y5��� <br /> Si ned_ A. <br /> rS_ T -Z -r. - <br /> t �- -------- ----- <br /> BY-, Title - 3 ,3:rae cf'S:L�v -r��� <br /> P . o ��0• "-0 17� <br /> th <br /> i(If e ban owner] <br /> ` @ <br /> ,• :I� _ - �- FOR DEPARTMENT USE ONLY <br /> Y <br /> ,E 1. - ------DATE. <br /> i APPLICATION ACCEPTED BY______"----- - • ------ -- --- <br /> ,E � - ---- --�----- -- - -' DATE `--_ :_�--- ------------ ---- ---- ------ <br /> - -- -DIVISION OF LANA NUMBER. - ---------------------------} <br /> 1° ' <br /> ADDITIONAL COMMENTS. .� �Z ------- --- -- --------------------------------- ------- --------- <br /> .IM° = ------- --------- ------ --- ------------------ ---- ---- ---- -- -- <br /> i _" <br /> --------------- _ <br /> _ i� __.__ �____ ________ _ _`- ----------- --------------- --------------- ----_ ____._____________. __ ------__--__- -__- <br /> _________________________________________________ _ ___-_ __ _____ <br /> --- +---- ...�..,... ..�-=•_r- s,..-.�._-.R-•r F�••� �-•^"�T,. R�7/76 3M <br /> Final Inspection bY:° '._ t �. --- <br /> 34 <br /> EH is sa ,,, SAN JOAQUIN LOCAL HEALTH DISTRICT <br />