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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------..__------ ----........................ (Complete in Triplicate) � Permit No.T�-�Olb <br /> -------------------............................ ------' 6 � <br /> ..............._-_... This Permit Expireskl Year From De J 9 Date Issued 14-14-, V <br /> lication 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 /> t j CSC t44OVr, <br /> JOB ADDRESS/LOCATION.--------------1.1-_6.91-.----...__6-yv r_et_p_Cis-f ------ <br /> �.-0'------CENSUS TRACT------------------------------ <br /> Owner's Name. - ---­----------rV'N't CT- - -- -------- -- - ----------------------- --- ------ --------Phone---RAJ 7-- -614---- <br /> fr i• <br /> Address------ ------ -- --- SAL . ----------------------- --------City--.©- K>o,141G. Zi <br /> Contractor's Name----------_.----- --­-- ------ -Af`FAO-e---------License <br /> #_. ---- <br /> Installation will serve: Residence(M Apartment House❑ Commercial ❑ Trailer Court ❑ <br /> N otel ❑ Other------ .---.----------- ------_. ........--- y�� <br /> Number of living units:------f____.Number of bedrooms.__2_Garbage Grinde(_-�_Lot Size__..a---7 <br /> Water Supply: Public System and name---------------- - -------- ---- ---- --- ---- -- ------------------------------------------------------Private)] <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan K Adobe❑ Fill Material... ........If yes,type --------------------.________ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) \ <br /> PACKAGE TREATMENT I ] SEPTIC TANK [ 1 Size-----_------.. ------------------------------------------Liquid Depth---------------- <br /> EX1skrokj Capacity---------------------Type / -Material-----------_.-._---._..No. Cor}tpartments--------------- `- . <br /> Distance to nearest: Well-_.. _-�____ __..........._.....Foundation_-/U__-.....Prop. Line---15­-- ---l...__.----- <br /> LEACHING LINE I ] No. of Lines-----------------------------Length of each line----------------------- __j-Total Length---_-.._.:.=.__.i-----------------_.._ �\ <br /> ,..J�5,�J 'D Box -----------Type Filter Material f Depth Filter Matefa -------------------------------------- <br /> !r, = Distana#to nearest:Well !! f Foundation__ Property Line... t.. ... <br /> SEEP IT I 1 Depth .. .... Diameter ,,V---------------Number . __.. d Rack Filled Yes❑ No❑, <br /> p rQ 1 Water Table Depth--------------------------- <br /> �-y� _._.. ......Rock Size._ ----------------------------- � <br /> IfXTTIOj(�7i Distance to nearest: Wall J-t1 --_ Pouridatiort:__ ��-..f..Prop. Linef;!T�_...14 ______ P <br /> y 3 <br /> REPAIR1ADbITION (Prev'. Son itatiort=Permit 4`-_;__._. __..;_ " <br /> . __' •--"-f-------------``--.:-----..Date.-- ------------------------------------------ <br /> Septic <br /> - - - - -----------•----Septic Tank (Specify Requirements)._-`-------- <br /> Disposal Field (Specify Requirements) --------- tel- - _ `^- A-11 -__- . -_ _.- .... <br /> .)C_.IU.x 1.2---------- .w,. »l - - - - - - -- <br /> ------------- -............ .-._......._-- ------------------- ------------------------ = ---- ----------- --------------------------------- -------- ---.._ <br /> (D]'aw existing and required addition $n reverse side)_ _ <br /> I hereby certify that I have prepared this Wplicd iodand that the worlCwill be clone in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of--the ..Son Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "1 certify that int performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subi to orkm-- s cap sahbrr laws'-of.California." <br /> Signed- .. __ ...Owner - <br /> By. -u - - �f C - Title <br /> - -- - (If other than owner) 4 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- -- ------------------- ----------- DATE.--- Z,, -- <br /> 5/­­ `­­` <br /> - � -----`- <br /> ..,VISION OF LAND NUMBER- - - - - - ----- - - - ------ ------------- . ._ __ DATE--- - - --- --...... ..... ....... <br /> �, , ITIONAL COMMENTS ----------------------------------------- ----------- ------------------------ --- -- --------------- ------- ------ - <br /> - --------------------- ------------------------------------- - <br /> .. ... -- ; - ------- - - <br /> Final I(lspectioJlby. - <br /> 04 19 24 SA PSILOCAL HEALTH DISTRICT t i ras z:an asv. rf 5 <br /> ri <br />