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J <br /> FILE COPY <br /> FOR OFFICE USE: �!. <br /> APPLICATION FOR SANITATION PERMIT <br /> ao <br /> ............... ..... ........ .... . . Permit No. 7�"� <br /> ( (Complete in Triplicate) <br /> y. <br /> Yi <br /> This Penrtit Explrg i Year From Date Issued Dara Issued ..tele' <br /> Application Is hereby modr, to the San Joaquin Local Health District for a permit to construct and Install the work heroin <br /> described.This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulatiensr . <br /> JOB ADDRESS/LOCATI ..} ...CIS�.. -R"!�... `!Q....................CENSUS TRACT .... .... ....,... ... <br /> Owner's Name ...... 00 <br /> ......».........».�..�.• .» <br /> ......... .... ...Phone.. <br /> .... . <br /> Address I.................. ... .......l..s:°�.City..... . .. ............::...............:........�..... <br /> Contractor's Name ...... -�, '=.... .. 4......................License c�P�. r�Y..» Phone .............................. : <br /> Installation will server Residence dApartment House Commercial MallerCourt 0 <br /> Moral©Other:.:...:....... (77 Ac R e S _. <br /> `Number of living units,.. . .... Number of bedroatts ... .OW120ge Orinder ............ IM Sia ..:�:�:'.:'� ...'=....». <br /> A'. �• <br /> Water"supply, Public System and Hama .........:.............................»............ :...,.». ..:..»r.............•................... <br /> Prlvah !' <br /> ` Chaeatter of soil to a depth of 3 feet, Sand[( Alt(3 Clay Q �Pkat(3 $pndy loam Q Clay Loam❑ <br /> Hardpan d Adobe C3 Fill Material............If yes,.type..............:........... <br /> ' <br /> {. *(plot plan, showing si:a of lot, location of system in Watbo to`wells,_buildings. eft must be placed an reve m side.) _ <br /> NEW INSTALLATiONt (No septic tank or seepage pit peimi"ed If publle sewer Is available within 200 feet, . <br /> PACKAGE TREATMENT [ ) SEPTIC TANK( I Sise..........»» Liquid Depth <br /> Capacity Type Material...............•.... No."Gompatiments <br /> S <br /> Distance to nearest, Well .......»..........:.•.:.........Feundaeion................»:...Prap.11.1101-- <br /> No. <br /> ine'....r......... —No. of Lines ...... ......__...... Length of each line........., ....... Total `Length ...:....... <br /> `x Ji D' Box ...... Typo filter Material Depth"Filter-Materlal <br /> ...... .....•ww.a».... ......:.:.•......».•s..•..........._...- <br /> Distance to nearest, Well ...................»..:Fann1datlan. .................. Property Lane ............ : <br /> 4� SEEPAGE AIT [ ] Depth .. Diamewr Number © ❑ <br /> s ..... ............ .........»»..: ..:... .......;'Rock Filhd Yee hie , <br /> "S' r ............... ..»».... ,. W <br /> Water Table Depth .....................r.........Rack Sia. » .._....... ,,, i <br /> Distance to nearest, WRIT ........................ .....,............Pli+op. Will........._..._...�. �, <br /> REPAIR ADDITION IPrev. Sanitation Permit <br /> / ...»... :. .......».»...»..»» Doh . <br /> .: 'Septic Tank (Specify Requirements) ........................ .»..».. ... ...... ......».:.... » ......�....._....�........_ <br /> Disposal Field (Specify Requirements] ... t4� ... -.t, .ie . .... . ... .... /......................------- <br /> .................. ........ ..............., ..........._» 4� a <br /> ±. •............................................................. .. .,»..................... »».»»r............ ,;j. <br /> (brow existing and�required addition on reverse side]. .. »» ` <br /> X I hereby certify that I have prepared this applitallen and that the was will be dens in accordonots with few Jeoquin <br /> County Ordinances, Stale Laws, and Rules and Regulations of the fan Joagrin Load 11161!1 0116li11d.Naas•rest e1 Ikea- <br /> �i sed agents signature certifies the following: <br /> "I certify that in the p*rfermance of the work for which 06 permit Is Isseed,I OW rat employ WW petaon I6 sods wwwa r ' <br /> as to became sublect to Workman's Compensation laws of California." r <br /> Signed ........................ ............... j �D <br /> (tf other than owner) <br /> _ FOR DEPARTMENT USI ONLY <br /> APPLICATION ACCEPTEDr�........................................................ DATE ZZ..-1:72................ <br /> . COMMENTS ... <br /> PERMIT ISSUED.-...'ENTS .... ..........................................................._... . DATE <br /> ............................ <br /> ADDITIONAL ......................................1—— <br /> 11 <br /> i ..... .................... ..... .. <br /> ..........-.. ................................ ................................................ <br /> ............................................... <br /> I............. <br /> . <br /> I Final Inspection by: ... . ,:, r:.L.0,w,-Y...............................................................Dalt.� : .. tea...................... �* <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />