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FOR OFFICE USES APPLICATION FnR SANITATION PERMIT <br /> ..................... <br /> (Complete In Triplicate) Permit No. .' .•"'••"'-'•""' <br /> Dats Issued .,1�7r71 .....,/ <br /> .......... This Permit Expires 1 Year From Dale Issued <br /> ! <br /> . F <br /> Application It hereby made to the San Joaquin Local Health District for a permit to r-sstruit and install the wont heroin <br /> described. This application I r: ado ip ompliance with County Ordinance No. 549 and existing Rules and Regulationse <br /> JOB ADDRESS/1.01CATION —CENSUS TRACT .......................... <br /> Owner's Name �Qt{►s....�E -fK ;+a. ...., 4.N..Q!rtAh .........................................................Phone . . '.335 ....... ` <br /> Address RIP.... 30.X. ............................. ............City .......G.Ir�� '�.��......--..................... �..... <br /> C-ontractor's Name ...........license tit ........................ Phone .............................^� <br /> r <br /> Installation will serve: Residence 0 Apartment House❑ Commercial(]Troller Court C) a` <br /> a <br /> Motel[]Other............................................ , <br /> Number of living units:-.A.....- Number of bedrooms ......f Garbage Grinder .VE3... lot Size Z.O.AC.f- 5........:.... <br /> Water Supply: Public System and name ..... .l=.p_..-.,.LJ.!41T. .R,.........1.1lrEtj........................................»Prlupte12 <br /> Character of sail to a depth of 3 feet: Sand 0 Silt[]. pay © Prat Q Sandy Loam❑ day Loam� T. <br /> Hardpan Adobe 0 Fill Ailatrrlol ............If yes type............... ............ noI <br /> I <br /> (Plot .plan, showing size cf lot, location of system In mlatlon to wells, buildings, eft mutt be placed an two gids,) <br /> NEW INSTALLATION: (No sep`ic tank or seepage pit permitted If public tauter i iWe within 200 feet,) 1 <br /> '. PACKAGE TREATMENT ( ] SEPTIC TANK Size...... ..L ---.7.!7 <br /> 1 ..... Liquid Depth ....!�....�.......»». <br /> Capacity ..J.0� .T...... Type fr�"f.f. Material..Gitd1 r!r j.r: No. Cempartmenh ..2......_._..r !` <br /> Distance to nearest: Well ......-. .,5-.d...:............Foundation ..... ........ <br /> LEACHING LINE No. of Lines . .... .�......... Length of each line......f .,,.......... Total Length . .�. .4.?.....»».. j.. , <br /> •D' Box .......r: .. Typu Filter Motorial S .topth Filter material ........—1.8............. <br /> t....,..».... <br /> Distance to nearest, Well ... 2d.O.......... Foundation .... . ...... Property Litre .-SLt........... <br /> SEEPAGE Pit [�- Depth ......7,,........ Diameter ...-/.>-1.... Number ...........:.3......:... Rock Filled Yes ®' No cl <br /> Water Table Depth ................. t..........I......Rock Size .....�..�..? t.......... je{ <br /> Distance to nearest: Well ...........Z TjdL ..............Foundation ...... ... Prop. Una .... <br /> REPAIVAIDDITION(Prey. Sanitation Permit 11t .................... Data } <br /> SepticTanl (Specify Requirements) ..............................................................i................._..................................»...........».... <br /> i <br /> Disposal Field (Specify Requirements) ................................................................................•......................................... .......... j <br /> ...................... .•---..... .......... .... ................................................................................ ...................................a...................... ' <br /> '? 1Draw existing and required addition orf reverse side).................................................... <br /> {i I hereby codify that I have prepared this application and that the work wit! be dere In sen- on" with lien dae�ritt I i <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Letal Health Dlstdtt.Nems ownw M Newf. <br /> sed agents 61,7natum certifies tht following: i? <br /> aI "I codify that In the perfe-manco of the work for which thIs permit is issued. 1 shall not employ any per$"Ile MKh matowas to j�f <br /> Signed K• a sub(act to4LtlWorkman's ns C�ftle:'140=2 :1CalifernM�N�r <br /> r (If other than ownesrl <br /> FQkD1PAj6MENT OW ONLY. ' <br /> APPLICATION ACCEPTED BY ���.'.�...... !C. kyr r �/l.,° 't�'` ...... DATE ... ...1 ..�.si <br /> BUILDING PERMIT ISSUED e <br /> ....... ...... . ... DATE .. .. .. <br /> ADDITIONAL COMMENTS ..........:.......... ..... ... .... .......... ..... ­ ­... . .. .... ...­....... ............ <br /> .... ..........•.......... ...................... <br /> .. ....... ......... . .... ...................... <br /> .... . . <br /> q ................ <br /> Final <br /> Inspection h �_ ..............Date <br /> �j I <br /> EN <br /> 13 2)t 1-6)1 }tov. I ✓�i. NICOAQUIN IOCAL HEALTH DISTRICT - 8/710 3H <br />