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FOR OFFICE USE: ' FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT y <br /> ' <br /> .................................. - Permit No./���� 3 X•� - <br /> (Complete in Triplicate) �-��--�-- <br /> ......... ............................................... <br /> Dote Issued,�4S'...? <br /> ......................................................... ( This Permit Expires I Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and.install the work herein describes <br /> This application is.mode in complioncewith County Ordinance No: 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION..-602.[_.49,...KE77_K (Y# 4!(/_.-LN......_G!»/r...._.............CENSUS TRACT........... .............. <br /> Owner's Name-- /4. ... uGhP.- -...P.. �clA/5�.. CE ._................ ..Phone.......��.,............_..-... <br /> Address---- .................. ....City.... .LOA./ .........I.............Zip:. ................. <br /> Contractor's Name...... ................__.................LicenseSPhone.. 1.-..: q S, <br /> Installation will serve: Residence El Apo fth enf se'yQ��$G'bninmercia Trailer CoLTR.0"�` <br /> {.w <br /> ate`❑' - -_ - - <br /> afheT-....""................-----------........ <br /> Number of living units;......... ......Number of bedrooms.......-. ..Garbage Grinder............tot Size..................... . ..............,..... ...... ..... <br /> F Water Supply: Public System and name....._. ... .......... ......._.....:.......................... - `••.�4Ka. -----..... .................. Private I <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt E] Clay ❑ Peat El Sandy. Loam �. Cla Loam C3 <br /> Hardpan ❑ Adobe Fill Material.. .... ..-.If yes, t(pe......: ..4 <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. ;u'.t be`ploced on reverse side,) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is cva\ilob\le'wiiF ih 2b0 feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK Size....:.....-S�X Q-� ..-----`+:• `.�Liquid 'Depth....:Sy e <br /> Capacity. t7.�b.Q <br /> _.Material :N Co partments:-.;,....----..............- <br /> I Distance to .............................. ...... 0:. f� .. ...Prop. 'ine..a�_................ <br /> . <br /> t a ength of each line....-.-/-Od'.-i.......Total`Length .. Do.�a-. •••---. <br /> ` LEACHING LINE [sY No. of"VIR03 �:"^ ..................-L { t } rr <br /> 'D' Box..✓....Type Filter Material...�`.!�.. .:...Depth Filter Material ................ .... ...... . <br /> j <br /> Distance to nearest: Well... .-...Foundation..../0..4--r-.....Prop" Line....;.....,.... -,,<- <br /> f/ 3(0 ..3 Rock Filled -Ye Nb <br /> SEEPAGE PIT [LY Depth-_o?: ........Diameter...._..._.....-...Number "'�— <br /> Water Table De th.---...%V..................... ................ ........Rock Size.:.........: :.........;... ..... :' <br /> P c <br /> Distance to n arest: W le ........................................Foundation...,..��J.... '.:�-:...Prop:•Line....S..`- :.. - <br /> REPAIR/ADDITION (Prev. Is <br /> Sanitation Permit#...:- .. ..-----...Date.,:1....:1{-----r.....�...�..l. ,l� <br /> [ Septic Tank (Specify Requirements)...... _. . ............................................... ..-......•-- <br /> f '1 <br /> 1 ,r _. <br /> Disposal Field (Specify Requirements).............. ---..: ................................------.--•-----•--F-.......�. ..., ..--- ,.` , <br /> y > �. <br /> c.........--- ............ ............: ........ t �: - } <br /> I i `�, <br /> (Draw weisting and required addition on reverse side) ��\� <br /> I hereby certify that I have p*pared this application and that the work will,berone�n a co dancw,� Ith�San Jeaqum, Cnf <br /> �44cMa h�Dis let- NomebwnDr ei licensed_ag <br /> [ Ordinances, State Laws, and Rules and Regulations of the San Joaquin Coca,• ` ` <br /> signature certifies the following: +, �,1 e ,~ <br /> "I certify that in the performance of the work for which this permit is issued, Itisholl not,employ,cmy�person In s an e <br /> to become subject to Workman s ompensat awjav�i —u£ California." <br /> ^ <br /> Signed.............. .. ................. . ... ...... .................:.........................Owner ��• 4 t., <br /> By . ..:. . . .. Title......-... .... _Q <br /> [If other than owner) <br /> ; • a > <br /> FOR DEPA TM NT USE NLY I <br /> APPLICATION ACCEPTED BY... . . .e -- -- <br /> . <br /> DATE.... � ..... <br /> DIVISION OF LAND NUMBER............. ................. .................. .... ...............................-. .. .. ....k....\..�` <br /> ADDITIONAL COMMENTS... ... .. .................................................. ...•.....---------------------------------- , .1z .~`. - <br /> __..............................._.-..... -.................. - -................._.............................. ... --- ......._................ ,` �...��.... <br /> 11 ......................:. - '. .... .................................. ............. <br /> --------------------- <br /> - . <br /> - _... patLs <br /> 1677 .. .. .. <br /> y�� �/ _ <br /> Final Inspection by: � .�GJt -'-'•-- .._. - .......... _............................ e. 'LS 1677 RfV.Ti <br /> (VCTPIr•T <br />