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W: <br /> is <br /> i <br /> x <br /> I <br /> FOR OrFI%'~ USE: I FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> � lComplefe in Triplicate) Permit No. <br /> i Date Issued <br /> This Permit Expires 1 Year From Date Issued <br />'<a:,cn is n:v,-by made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />,pc;'-;ntior, ;s made ir. rs,,l trance with County Ordinance No.549 and existing Rules and Regulations: <br /> ADOPESS LOCATION r_ �^�� '�t- /�7% �:= -` % '�� �el 'r� CENSUS TRACT <br /> it- s Name � t{e-7;, ��fi Phone <br /> r r <br />;rsc /�:;' �J .�✓'���'2r.�'i� r� �_;f�li•�..' City Zip . . - . ... ... <br /> tractor's flame 1(..A-',,# L' �,�,-�> P�! License # o�]/5.3 9 Phone <br /> illation will servr: Residence[ Apartment House ❑ Commercials Trailer Court ❑ <br /> Motel ❑ Other. <br />,ber of living units: Number of bedrooms .Garbage Grinder Lot Size r•'�""'"' <br /> er Supply; Public System and name Private <br /> ratter cr soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat yi Sandy Loam❑ Clay Loam�] <br /> Hardpan [j Adobe fill Material If yes, type <br /> pinn, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> F WSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> KAGE TREATMENT [ j SEPTIC TANK. [f.}- �( Size �c��J}� �.. Liquid Depth '7�. . . ..... <br /> Ca �+� A <br /> acir 4f"` } <br /> P Y���� Typplr,,1'i l_etti,� h'Iaterial � . No. Comportments. <br /> Distance to nearest: Well cfCl roundation Prop. Line .,. '.of V' � <br />'RING LINE )L4e No. of Lines Length of each line � Total Length yD <br /> 'D' Box v l <br /> Type Filter Materia (' Depth filter Material ��... ` <br /> r �., <br /> Distance to nearest: WellC:'�. Foundation �D .Property Line ,r�. .. L. ...-...- <br />'AGE PIT (� Depth .r Diameter ✓ �,.Number ,r Rock Filled Yes No <br /> Water Table Depth . ... . r/co. ... . . ... .. . _ Rock Size. � ..� r <br /> Distance to nearest: Well Vo 0.�.� Foundation /Q r . Prop, Line '. S A_1-!7" <br /> IIR'ADDITION (Prev. Sanitation Permit Date <br /> is Tank (Specify Requirements) , <br /> local Field {Specify Requirements) <br /> (Draw existing and required addition on reverse side) <br />*by c@Mfy that I-kava prepared this applicattan and that the work will be done in accordance with San Joaquin County <br /> none", State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> nture certifies the following: <br /> Wify that in the performance of the work for which this permit Is issued, I shall not employ any person in such manner as <br />*come-Ob}ott to Workman's Compensation laws of California." _.�. <br /> ed ^-K_ r r: c Owner <br /> �Crrr'J� .• :' .. Title .rr <br /> ill other than owrCerl <br /> �J Felt DEPARTMENT_ _ USE ONLY <br /> IICATION ACCEPTED BY /r<',',r'c''r ��CCk� ; r --- DATE . F <br /> 5101\1 OF LAND NUMBER DATE r <br /> MONAL COMMENTS Frf Ce" 5/.5</K Zx` 1'33 ° <br /> .��' <br /> I Inspect+rn by: ``'f.-{.nt, ,~r.c( <br /> Date �3G s7 <br /> rr^^ <br />=t SAN JOA UIN LOCAL HEALTH DISTRICT r f FRS 21677 ON. 7176]M <br /> h, . <br /> 4"AYiY�^ 1:'9l{•_.uY .b.WES NF^:. ._�1rttdf C.k.�r -i i. ..H .�-,�:.u..._ -_".�'�: �[ '. ` -. <br />