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<br /> mei FOR OFFIC•
<br /> E USE:
<br /> Ow OFFICe use: •I APPLICAYION FOR SANITATION PERMIT 7�. oy
<br /> . Permit No.............•.........
<br /> (Complete in Yrlpli(ate)
<br /> -- Date I ssued_,5'.'3:�=•
<br /> . . Yhis Permit Expires 1 Year From Date Issued
<br /> .......................................... ..........
<br /> 'luct and Install the
<br /> for a
<br /> ermit to
<br /> Application is hereby made onh fiance with CountylordinancceHealth sNot549 and xist ng Rulies nd Regulations:work herein described.
<br /> This application is made In fo p -M•-^
<br /> —_ I ' t :SCG• D. y�' 1 � ,Z. .. .. ._
<br /> ' License
<br /> • ► ,?,•-?•
<br /> CENSUS SUS TRA
<br /> C..ZT
<br /> ............................
<br /> .p.......s<?._
<br /> •.
<br /> �.... ........ • %
<br /> CATION_ _.....
<br /> JOB ADDRESS/LOPhone
<br /> I. .....ame.. T + . , � N ..............
<br /> ................ ............ .
<br /> Addressone
<br /> ,2 +, ..;...license
<br /> Cohtr (� ••'••"• """""""" .... .t.— .1
<br /> ,
<br /> ' • -r
<br /> Installation will serve: sidence
<br /> Apartment House C7 �Commerftal Q Trailer Court ❑
<br /> Motel (] Other.:.:....::.:.......... ..:...LL_ ...; t _........- ............. .........._.....
<br /> i 1 t t Size
<br /> Number of living units ;__ Nuniber,of.bedrooms ._.._:....Garbage•Grin er ....__•.•�- o • ri
<br /> t I l L . ...... ...............P 'vote��-
<br /> Water Supply: Public Syste .and.name,;;Character of soil to a depth f 3 feet: > Sand Q SI [] 'CIaY Cl r .ar_Cl Sandy loam C7 CIaY Loam[)
<br /> • " Adobe Fill Malerial.:.._.:.....If ye's,type........................
<br /> ' a Nrapan Q .� _ :
<br /> is I..
<br /> {plot;pla.A&showing size of• ot, lotation of•system in relation to,vy-ells uildi�gs,•etc,jnust be placed on reverse side.)
<br /> NEW INSTALLATION: �lN'septic tank or seepage-pit permitted.ifrptbl+c sever is available within 200 feet,) ,
<br /> � ,.` r* ..._.... .:.:t._.........Liquid Depth.......... --
<br /> PACKAGE TREATMENT' [ J•
<br /> SEPTIC>TA�iK" ' : Size.:
<br /> + a erlai + !•No. Compartments_.....
<br /> ► -�
<br /> t.. • � � ,. .. •Opacity ......... .. .. e..._ ,.. .,._ . _ � .. •
<br /> ......... ..
<br /> :•t2
<br /> G't ! D�is�tance't0 nearest;\ke11.:JD
<br /> Foundation./ Prep.�Line.�Q� ••(3
<br /> 1
<br /> r -......._.
<br /> t '
<br /> •
<br /> + � pp ._ -:-�•:•:.,�.._,..Lengih of e�ch IinQ, ...._...._.. ,. ..... . .
<br /> LEACHING-1.101E [;I.. Nb-of lines., 1 t
<br /> ii :: i . ..
<br /> f D� Box. Filter Moterial..f ? •...•Depth Filter Materiai_.�......................................r1
<br /> ,.. + r
<br /> •D;pfh...;,`5..
<br /> stancejto.'earest:Well.:... A.Foundatlon...�..._. �.................Property Line......._.....;._;_.__..........._..I
<br /> a __ Rock Filled Y N
<br /> SEEPAGE PIT t [ ) D-� ' ..Diameter.._... r ..s•---Number_.{• ; ---..�.._.: ..... s R es❑' o
<br /> 1 ..................t.. $j .................
<br /> ?. ...�. . ,.....•t.. i t
<br /> 1 # +ater faille;Depth...r...... .. .. .. .. ..Roc z i.;....t...__.. p Line.......... ..:_....
<br /> :F k Size
<br /> • c.: .•.._..._-
<br /> �nearest Wel{..__.... t t...... ........ oundatiori........................
<br /> ..:_..._ . ,..Pro
<br /> D stark �-...��_ .yam �:.. �•. 3
<br /> j e(rsi1 '"....�..,.., r. ..,,.. DatQ" ... -- ` '_"'....)
<br /> REPAIR/Ali 1T10N (Preva�arlltati'OT1"P •••-••••••• w ••••••••- ••-•...........+• •••
<br /> ;....._
<br /> Septic Tank(Specify.Requi,emsnfl). ..................... ....,.....5::... :,. ........... ........r:............L:...........x......_...........................:1......
<br /> +_..;�..
<br /> Disposal Field (Specify Requirements) :_.. .,., •;_.....
<br /> ...............................
<br /> .......:......:................................................. .
<br /> :_...._,..............
<br /> .....
<br /> . .). :... _. .. -- . ::.....................
<br /> ... ... .... .......... .........._! .. ......:....._....._.. + .. + .. .. ....' .-.i..._:::.. .3...__.....-_...:_...--- _-...._.. ....._....._...._...._......................
<br /> _ �` t
<br /> ((Draw existing and required addition ori reverse side)
<br /> *
<br /> 1 h rally certify that'1#1a"a prepared:this application and ihat'the work will be done to accordance with San Joaquin Countj
<br /> Or inances,t State Laws; .and Roles-and Regulations of:the_San Joaquin Local Health District. Home owner or licensed agent+
<br /> slg`nature certlfids t'ho folitwing:
<br /> 111 certify thavlfiithe performance of the work'for which this permit is Issued;I shall not einpioy any person In such mnnnerla
<br /> t to become svb)ect- to Nvorkm r1�s Compensatiori'lows of California.".. r
<br /> _.. . Owner
<br /> By'.............. ... ............ ...:......i_......... + ._... :..... .... ._Title.......... .._......_. .,•. ...r..._......_..._._:...__......._......:.
<br /> .....
<br /> t (I other than 6w. r r) I
<br /> .s-
<br /> ( 'FOR DEPARTMENT USE-ONLY +' '
<br /> APPLICATION ACCEPTED BY., c �� ............. ...;.......__.DATE...,, -,. r'.7 .....
<br /> OFLAND NUM ER.......t........ ..............__...... .-::---.__.... ---....:._...._...._....._..._........: .....;_..DATE.............._}. .:_.. ::.._._......:..,.
<br /> ADDITIONAL COMMENT .. _.. .............................. :............:....__...._......_
<br /> ................ ::......_......__....-----•.....•--.....__.. ..... . ............_.........:;:.._.........�. ..._._ t
<br /> %................. ............ ... ...----• , - .,,.... --. ._. _r .............. % .............._��...••.--..........:................_......
<br /> Final Inspection'by::... { :_ :......................-......._....-._.....'.Date... •. ".� .....--
<br /> EH 13 24 + SAN JOAQUIN LOCAL HEALTH DISTRICT W 21677 REV,7/76:
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