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'PLICATION FOR SANITATION PEkvweT <br /> (Complete in Triplicate) Permit No. ..7. ............. <br /> ............................................... This Permit Expires I Year From Date Issued <br /> Date Issued .E: :.�% <br /> `Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> � ._... .. -. <br /> . - . .. . .. .. . _h .. CENSUS TRACT ...L!&............_..J BDSeLOCTION <br /> Owner's Nam <br /> 7.1. ........ !L:................................................ .... ......Phone .bel'%:'a <br /> 4ddress .5/tEi-r_.-.ct.tla2:ve..,........." ._ - .....-... .............. ........... City _... . ...._.................. <br /> r <br /> `contractor's Name ......_--USC?'!:<.G.�_._�5— -.r_tr!t.................................License # t....iL^ ........ Phone ....... ............... <br /> 'nstallation will serve: Residence ❑ Apartment House❑ Commercial ❑Traller Court 0 <br /> .. Motel Other . ��7✓../ �dc� r 1 t� <br /> I <br /> Number of living units:._-/..... Number of bedrooms ".,.';._-..Garbage Grinder . ✓... Lot SizaT.Q�... !'E'f_��..........�S <br /> Voter Supply: Public System and name .---...--.------------- ---........................_....................................................Private <br /> 'Character of soil to a depth of 3 feet: Sand X Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type ............... ............ <br /> 'jPlot 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 /> ACKAGE TREATMENT [ J SEPTIC TANK j ] Size._-_l C�......4,........... Liquid Depth .......................... <br /> Capacity /4.4 t ...... Type":� y7:... Material_r4. ; 9............ No. Compartments 7 <br /> Distance to nearest: Well :.- ti.Z1.:.Y...................Foundation ....... Prop. Line --- `?-. ........ <br /> s <br /> TEACHING LINE [ ] No. of Lines ..._.-1..._-.._.-- Length of each line....,..� :�...y... Total Length .. �Q.._.-.-.-.". <br /> 'D' Box r, _3•,. -> <br /> �.._... Type Filter Materia)fc�.:''!?....Depth FiJtas-Material ._-. ....,✓:?' �.................�..." <br /> r, Distance to nearest: Well ....3-: ..:Y.-"" -- Foundation .--../_ZG.a..�.-..-. Property Line ......). 7L......... + <br /> SEEPAPE, PIT O Depth ... ..�. . -- Diamet ----------- ---- Number .......... -- .... ock-_filled Y No ❑ <br /> Water 4{e Deh.----- --------.... - - Ro ize .. ..... ---------- <br /> Distance <br /> -- ----.... <br /> Distance to nearest: Well ................. Foundoti Prop. In .-.. <br /> .. ........ <br /> 0EPAIR/ADDITION(Prev. Sanitation Permit# ........ ................................... Date ----------------------------------) <br /> SepticTank (Specify Requirements) ..........................._........................................-..................................................................... <br /> Disposal Field (Specify Requirements) - -----------......................................................." ...........-...."..-__-......... ...­ -------"........... <br /> _. <br /> -.. ..-_.._____. _...._.........----_....-._................... ............_......................................... .........._----..........---_-._............................... <br /> .-...-..._.....-_. .....-..----.- ..............---".""_____....-"._.......--..._...----.-...--`............_....._........_......__...._..............................._. <br /> (Draw existing and required addition on reverse side) <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> aunty Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner <br /> to become subject to Workman's Compensation laws of California." / <br /> Signed ._. ..........-........ .-..._.."--- - Owner ``n^JF�--J•1f <br /> t _. .. _ _.......-_. .._ _ -...... .__. .. _._-.__....- . . _._. Title - _... __. . _.... ... <br /> (If other than owner) <br /> IFW DEPARTMENT USE ONLY <br /> 'PLICATION ACCEPTED BY IING COMMENTSPERMIT . " - x .. .. ..- .-._._" -._:.. - ..DD_ATE 6 1.7 7�i......... <br /> 9FJ <br /> DATE <br /> ADDIITIONAL . ....4i¢::.77 _.! <br /> ....... ....... <br /> Final Inspection by. __. . ._.. Dole (o j J�7� <br /> F 13 21t 1-btl ltay. 5m 717 <br /> JOAOUiN LOCAL HEALTH DISTRICT 8/7h 3M <br />