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9R OFF.iCE1 jSE: APPLICATION FOR SANITATION PERMIT Permit No. <br /> --`Q-- s---•--.-.'._.....„---'................. r. - (Complete in Triplicate) (ri <br /> Date issued .... , <br /> ............................................... . This Permit Expires 1 Year From Date Issued D7(_ (�!O —b5 • <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work stein <br /> described.This opplicatia> a e in compliance with County Ordinanae�o =dex'StI g S TR and Regulations: <br /> Gac.T!�TIE <br /> Owner's <br /> - �)eM/-_//�?l�f_�.--�--r(-/°-'V`� - .0..�.WN <br /> TRACT . ...................... <br /> JOB ADDRESSAOCATIIION .._ , - -- ' phone.) ----� - - <br /> Owner's Name ........!•(-•-- _ L. :'!...._.._..-------..>--...---.._...:... ... <br /> Address . ......-'---. _Lcense#113',W. <br /> Phone... ......................... <br /> Contractor shame <br /> installation will serve: Residence p'Apartmant House q] Commercial❑Trailer Court <br /> Motel p.Oth€r... <br /> Q7 . ... <br /> Number of living units:.��Number of bedrooms Garbage Grin/d`e�r�...:....__.. Lot Size <br /> rivets❑ <br /> jJ�� -7`//'' I fJ ._.. <br /> Water Supply: Public System and name,tL'./IJ�. [ A�-/>- - - / -••_---- <br /> Peat Sandy Loom❑ Clay Loam fl <br /> Character of soil to a depth of 3 feet: Sand U Silt 0 ^ Cloy ❑ L� <br /> Hardpan(]/'Adobe :Flll Material ............if yes,type <br /> ! laced on reverse side.) <br /> Lq <br /> (Plot plan, showing size of for, location ,of system in relatio to wells, buildings, etc, must be p <br /> NEW INSTALLATION: (No septic tank or seepage' <br /> perniltted if public sewer i5 available within 200 feet,) <br /> t� i . 'r L [� <br /> ` Size:..... �.�..�Q.._.. � Liquid DaP* - ' <br /> PACKAGE TREATMENT ) SEPTIC TA k ]i6R1 �� No. Compartments <br /> ,(, / 1 <br /> :opacity R. l Type .__._._----:.=�'�hnterwl kx"....... jam„ -. Prop. Line.ftl.:�/ �46T.-•..-. ' (tt <br /> O - Lvl Foundation Zd <br /> Distance to nearest, Well __ ��Jf ? ' 1. <br /> t /) To <br /> Length ,.f' x--c••:.._..._. <br /> + o <br /> LEACHING UNE No, of Lines Length of each ISne._...h Filt --•t---.. -._._.._.�... +� <br /> ,,._, ^^ epTh Filter rN retial ......i!e..�-- <br /> J t D' <br /> Box ............ Type Filter MaterI017 j / <br /> Distance to nearest: Well _... r1� -•- Foundation; _ •-- -- Property Line .-� .�f ` -+• <br /> Diameter ................ Number ------------ Roek Filled Yes <br /> No O <br /> ' SEEPAGE PIT I 1 Depth .--.----•--.-- •1- r • �n <br /> I '..,Rock Size __........................... <br /> Water Toole Depth -- '---..,.{_.h. -y..7i <br /> Distance to nearest: .... .........._..._,_,.J-JFoundotIon,.M. -- Prop.line ...=­-•-.-..-.._... <br /> ,,��'' <br /> REPkiRJADDITION(Prov. Sanitation'PeFYnit#....... _ i .. .......^................. 1 <br /> _.r. <br /> : Septic Tank (Specify Requirements) ...<.------------;----__-.•-------._�....-----<v_:-..._... ..._"c-----'----_.........._..,... <br /> Disposal Field iSpecify Requirements) ........................:...........' :'"---r-` j _ <br /> p --`................ . .: <br /> v t <br /> - _. . ._:..._.. l - 1.............. .-fr <br /> - - <br /> (Draw existing and required addition on reverse side) <br /> t <br /> I hereby certify that i have Prepared this application and'that the work will ba'done to accordance wlfh•Son Jraqutn- <br /> County Ordinances, State Laws; and Rules and Regulation of+the San Joaquin Local Health 7".. Hams oixC ,$,1�een-� ' <br /> sed agents signature certifies the following: ..`✓ f 'onto such manner <br /> 11 certify that in the performance of the work for whiSh oris permit is issued, 1 shall not employ any pets. <br /> as to become subject to Workman's Compensation laws of Ccfo itl <br /> ._.---- <br /> ..^-•�.-i-.......... OvJner �r <br /> Signed .....__......_............ ----------... - w <br /> .-�---..............__......,........... <br /> By........ ...._./' <br /> ......__..------------- ........ <br /> .__..... -----..-- --.- .. <br /> pf other than owner) / ! <br /> -••---'Fol(-DEPARTMEAT USE ONLY <br /> 51 .---` -----,u.-.-,/p/tlt . DATE <br /> APPLICATION ACCEPTED BY e--- /p ;_-' .-�`t,. ._.......DAT .....................................••-...... <br /> BUILDING PERMIT ISSUED..._.r... --' <br /> L ,.. <br /> ADDITIONAL COMMENTS - = ;. .................. ..... - .......... .. <br /> .......:.:... .....�.._.:.....................--' ..._......._. - ..' .........----- <br /> -...... _.....---......._... -' <br /> - €..............---'fir..-.: <br /> _ P_:. .._ . <br /> - ”- <br /> inspection <br /> -•-- ....... Date <br /> .. .......... <br /> ----------------.....:....� ..._....-----•-- <br /> Inspection byi_. ._ ..._......... . - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> , <br /> E.H. 9 1=68 Rev. SM. <br />