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-FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> (Complete in Triplicate) Permit No.-.7 -__ 4rl <br /> ------------------------------------ <br /> Date Issued-- ��- --------- <br /> Application <br /> -77 <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�---"----_ __, <br /> f-i--��}JI/$a�✓ <br /> CN „ --------- -- ----- <br /> _ <br /> ---- <br /> IF Ow�ner'sk' Name - - } <br /> Address <br /> � C ------- <br /> _ - - <br /> 1091<Z <br /> - --O-- <br /> - ---�-- ------------------------- <br /> CO <br /> z ;city-- - - ------- <br /> s --------------------- ----------License ---P-haE o_n-e�-tep <br /> Installation will <br /> -- <br /> serve: �- -�`.- Resid � � ' <br /> t --- <br /> ence Apartment House.❑ Commercial E] Trailer Court ❑ <br /> _ , f . 7 Motel ❑ Other -------------- <br /> --- - i <br /> Number€of living units:-- -r.---------Number..of.bedroomsr� _____Gaba e-Glinder- __._,.__Lot Size---..__ — <br /> r 9 — r- --- == - <br /> Water Supply: Public System:and name.__.-________ ' <br /> 1 <br /> -------- <br /> ------------- <br /> ----------------- -------------- - --- .:- -Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silfi Clay ❑ Peat❑ Sandy Loam Clay Loam <br /> I <br /> s Harclpari ❑ Adobe ❑ Fift Material----.:____ If yes, type ----- ----- <br /> --------------- <br /> i 1 ' <br /> (Plot plan, showing size of Iot, location of system in relation to wells, buildings,etc. must be placed on re terse side.) <br /> NEW INSTALLATION: '"(No``'septic tank 'or-seepage 'pit permitted if public sewer is available within 200 feet,) _ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ( ] ,Size ---------. - Liquid Depth-,��_`_-- ------------- <br /> Ca <br /> -�f-----� <br /> .- Capacity) _--_:Typ •,e --4$7 :_-_No. Com artme <br /> I — - ----- Material---'--------- -- p i uints-i ------- <br /> 'D <br /> :- s <br /> a ; � - <br /> Distdnce to.nearest: Well-'--- ---_--__Foundation:_' _ <br /> -��-----' --- -- Prop. ine---4r4: ] <br /> LEACHING LINE' <br /> 4- - Lengt f each <br /> - Bre------ Length- =-�- -------------Total - ----�' <br /> --.-f--- <br /> - <br /> D Box--- ___.,_Type <br /> Filter Mat ria)-!_ .repth Filter Material_.--__ <br /> Dis -------- -------- <br /> a �- <br /> s . ; V1 <br /> t ncc�to nearest: Well--- ------ - ---- -----Foundation- ---------_-:_--.Property Line-k-_�J-------------------- ------ <br /> SEEPAGE PIT ] Depth---- ----- Diameter.-----_- _y___!--Number--- ------------ --`_-__- , I fi <br /> -•-�. . • Rock Filled -Ye ❑ N <br /> Yes o <br /> j W t!r Table Depth ------------------------------------------------- <br /> -------Rock Size------- ''----- --- - h❑L i <br /> IIi <br /> Distance to nearest:'Well-------- ..--,- -- ------ ound `t' n ------:------------' <br /> t F a Pop. Line ------- -- <br /> r <br /> DDITION [Pcev. Sanitation Permit# --�---;-- - --"Date------- <br /> Septic <br /> "--�..`. <br /> 5e tic Ta s ' � � E - <br /> PA[R A # <br /> p ( nk (Specify Rei .ej�vments] 9 t <br /> { <br /> -. __:-:_ ---.-'��------------------- -� <br /> - -- <br /> Disposal Field (+pecif� yRequiements):_.__-.--� ,A- - = ` <br /> C ] <br /> r -- <br /> ------------=--------------------- --------- �' ti <br /> ----------- -::_ . <br /> - ------------ (r <br /> -- --- - ---- <br /> F <br /> _ . <br /> t -� ,� --- <br /> --------------------------- - <br /> ------------------ --- <br /> -A%-.- ,(, [Draw existingi gyred addition-on reverse side] - - <br /> hereby certifyUat.l have rere .may `` �' <br /> p pthrsdpl3hcation and that flied-work will be done in accordance,with San Joaquin County <br /> Ordinances,. State ��ws, and-Rvle's and Regulations of the Son ogqu, Local Health DisMict- Home owner or licensed agents , <br /> signature certifies the foil ng: + '\ <br /> "I certify that in the p rformance of the-work for-which this 'permits is ssue <br /> to dtshall not employ grit' prso in such manner as <br /> g me sub' ct ,t rkma '-Compensation laws of. Cdliforn�. <br /> Signed eco <br /> Owner <br /> BY s - ---------------T <br /> ---- i <br /> t1e---------- ' <br /> [If other than' owner] ,_ <br /> _ I. <br /> 1 �FO EPAR ENT USE ONLY N' i <br /> APPLICATION ACCEbTED PA . _ l t . l <br /> --- -------------------------------------------- <br /> DATE ---- �_ <br /> DIV1510N OF LAND @l1JMBE�R.-_.�,_. -� .. -... - , <br /> E t ` <br /> ADDITIONAL COMMENTS ---1 ---- <br /> DAT <br /> - _ ------ ----- --- - ---------------------------- <br /> I ------- --- ------ -------------------- - ------ - --------------- ---- ---- ---e --- -------------------- -- <br /> --------------------------------------- <br /> - <br /> Final,Inspection-by:..._ _ - . �� - � �. #- ?e --- -------- <br /> _------------- ] <br /> EH 13 za SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F85 21677 REV. 7/76 3M � <br /> # W <br />