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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .._.. _ :_._--------- ................. Wasoples, In rtlp`Ihxts} Permit No. .�Aba.� <br /> /� Dare <br /> '. ...-..................... <br /> __....... ..__.- This►ennil Expires i Year F&%Daft kssred <br /> Application is hereby made to the San Joaquin Local Health District for c permit to construct and install the work herein described. <br /> This application Is made in canpiiance with County Ordinance No.54_9 and existing Rules and Regulations: _ - _ <br /> f [ ,rte r /f,/ / <br /> JOB ADDRESS/LOCA d /f3 . 1s� _'_,.....-__.-------.------•-- US TRACT C.. E�- t.74 �. <br /> ,. Phone.- 17-5. <br /> Owner's Name.• i s t./.� •+�.......: : . ......_........_ --CENSUS- P.r .. ..:�m�J•_---..:-:..[_:....+Caly- � .....--____._ _ _ -------- <br /> Address <br /> ..- Z <br /> Contractor's Ncrne�_--- - —� f "-- - ''s --------.--.....------......_ uael�. #. ?�1-.: ----Pr,ane-. ' 3 --- <br /> ln„tallotion will I•• - ; Residue l Apartment House)] Camsne I❑ •Trailer rt Q . ' <br /> .. i Motel 0 Other..::.:_<r— = `- -------------- <br /> size <br /> -------• 1 "* ' - <br /> 1I r I <br /> Number of living u its:..`_.�.'-.-.-Number of bedrooms,,L...Garbage.Grinder--:_•_,..LW Size-.._._ '._.:-�<--.-•-......�� <br /> � . --- - <br /> Water Supply: Public System and`namel---------`--.-,:.,..:-;::.. - ..... ....... - '----— '------ <br /> ChuSand Q Silt❑ Clay-I� Peat Loom <br /> Sandy Loam❑ day d <br /> rocter of soil t!a depth of 3 feet: - <br /> iHardpan Ej Adobe;❑ Fill mcteriaL....:.-....If yes,type...................... .... ) , <br /> / <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.must be placed on reverse side.) I , <br /> NEW INSTALLATION: [No-septic tank or seepage 13if--peimif}ea"if p'vbTic sewer is ovarloblew'ithin 200 feet,) r <br /> LL c' 1 N <br /> PACKAGE TREATMENT ['] SEP.TICTANK LST � ' Size_...SXJ.t�Yo.Q�� i_:__ -_l'puid Depih.s� ._...._. : A`r <br /> I Capacity-AZD-O <br /> -.----=TYPe• - ..... Matxfal:__C QAL.1-:-.__Nd:Cam rtfs_._.......�....�.y._...._........... <br /> _. - -- <br /> Distance tonearest, Well---_-.�?�--._..__.. Foundation-_fit-�.-.....---.Prop. Line-sem <br /> 1 : - i <br /> LEACHING LINE I�No. of Lines-----Zw.. .. . :Length of ep>:It ins,-._ . �-:--•.:....:......:.._7olaf.Length..'-.1:r'�.,------- <br /> S ri // <br /> 1 :D' Box_ stype Filter Ahateriall� .......--..DtPiF!Filter Malenol_;�et �_-._._ __-..�_r - i <br /> `� /''�� Qp .--.........FbundatIon- --- - " Pr�iy' tiled Y N 5 t <br /> j Distance to neorash Well.__..._.. <br /> i <br /> I Rock _ es Q o❑ <br /> SEEPAGE PIT j )I Depth •.DiameM------_ts.-...--,---Number-.--..._.-------- ;] - <br /> De q¢E"sw/ r <br /> ! ♦ r <br /> I : Water Table Dep!h----____ ___-_..____------- -.Rook _..-•------....-_E....... - - I <br /> * LOW-- <br /> Distance to nearest:Well_--.._....._-M................:____FowldaMors.__.__ .0 -.-_PFup. Lirw_--- ----...._. <br /> REPAIR/ADDITION IPrev. Sanitation Pe� t#_-.--------------._:...::_..._.t.__:.._..-...:pWe_..._,-_:»___!-:�._-_v.•..__-.) <br /> Septic Tank (SPKIfy��R�--•r--�4_.......... ...... .,..... ._...__._.-.. - �.....- ,. . - .. ........ <br /> .._.... ... .- <br /> (SIMHY Requifementsl:Q <br /> Disposal Field -. ...--•-......----._..,.�:�..-,._......_.---r---- <br /> �T ............ .................... <br /> _ ----- ) <br /> F (Draw existing and required addition'on reverse side) <br /> I hereby certify that 1 have prepareel this application and.that Jhe-work will�b�done in accordance With San. Joaquin�'L'OYnty <br /> .. <br /> Ordinances, State Laws; and Rules and Regulations of-the Son Joaquin Lecol-Health District, Home owner <br /> a tkaasod�agents <br /> signature certifies the following: _ r C <br /> "I certify that intheperFormbnce of tlie�"werk'fnr which this permit Is issued, I shall net employ any poison in such-ri,anner as <br /> to became W. : <br /> kn dn's mpensation laws of California." <br /> g• .:-: rnor_.. iiia . tiY� _.�._._.._..other than awriar) <br /> ! ROR-F>iEPARTMENT USE ONLY, •`` " ' - ' <br /> . ,.. .. <br /> APPLICATION ACCEPTEtYBY.--_-- ----- � __-- -------------_ DATE_:'-I. :�- - -- <br /> DIVISION OF LAND NUMBER.-. i —:---•-= :_ ----------------------- <br /> :- - DATE _-- -^ -.. .. '.. <br /> ». :•- <br /> ............... <br /> DolnoNAt coMMNTa <br /> E -..-----.___..._-- ,_..-..._..-...------• <br /> _..__.__-_r _—_—.._ .__.._...-•-3-__ <br /> 1 -._._ '_ - -__ - _ <br /> . _ - <br /> .............. <br /> DON <br /> Fktul•Ins -. �`�.-_ <br /> pection.by,:= <br /> rassl nasss <br /> W 13 24 SAN JOS AQUIN LOCAL HEALTH DISTRICT <br />