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a FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> I <br /> Permit No.'.- <br /> (Complete in Triplicate) <br /> } 3 Date Issued <br /> This Permit Expires 1 Year from Date Issued <br /> and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health`District for a permit to construct <br /> This application is made in compliance with County Ordinance No. SAQ and existing Rules and Regulations; <br /> CENSUS TRACT <br /> JOB ADDRESS/LOCATION �, i�3 I 7i_'�t_(,c.•� � � -�/ z-+ ��"': <br /> Phone 1'l�%-�_�".......:,. y <br /> �1 �. 4 <br /> Owner's Nate Z <br /> -�-_ 1 <br /> F.ddress /rf.. f • =J kl= /'i-' License # :� Phone •. . . ., . }< <br /> Contractor's Name . <br /> fTrailer Court ❑ <br /> tnstollati.on will serve: Residence ❑ Apartment House El Commercial (! i <br /> Motel ❑. . Other <br /> Lot Size �.:-c--r- <br /> Number of living units:`" Number of'bk-drooms ► .Garbage Grinder. I Private ❑ <br /> Water Supply: Public System and name <br /> Character of shit to o depth of feet; Sand r Silt>J Clay 7 Peat ;� Sandy Loom [j Clay Loam[� 4 <br /> Hardpan [- Adobe r; Fill Material If yes.type _ I <br /> 1¢Eot. plan, shLw,rirJ %- e c{ (or, Iocrrt,br. Of sYSt@.n iri r^l ran to well•.,bu*I,rtgt rrr`mVif i ri plcced ,n rP iCriP 5i<f .l. <br /> � <br /> i,� n1t G* id"N H t.4 m,Rtl �� rwt`5'L o'0Y'-F4 ;l'.1'i•1' rt1:rP w.,•k..�7-0c.Ili INSTALLATION, fNc.root t <br /> .7 <br /> o s+P <br /> �3 +�� x v� laturd 'Drp•h <br /> P1�V.F01 !i?EATI/fNT t j 5El'TiCrAlirv,•.('.2 �5�-e %i�� _ ' <br /> i c cwt w^^ s <br /> Typ�r .-Malw.c' .i ! t'= r <br /> e" Fn„rieInt+hrt r'd hfeLi (.it1a <br /> t7 irlprA rn nnriYer,}. WAIL ;, fis;x.d .� ' <br /> 4 <br /> - 'D' Box+' Type Filter Material,� Depth Filter Mcteriol. <br /> t;r' Foundation : .:C Property Line, <br /> t- ,f <br /> �_•����, ., Distance to nearest:Well . <br /> r ��X./C Number f Rock Filled Yes [� No❑ <br /> GE P1 19 Depth f]►arneta t <br /> ' Rock Size f ' <br /> Water Table Depth.... �:I.f,r...... / - <br /> � <br /> Distance to nearest: Well '< r....:.. Foundation / Prop..:tine ���.-. . .-... + <br /> } v <br /> REPAIR/ADDITION (Prev. Sanitation Permit# <br /> .:Date' <br /> Septic Tank{Specify Requirements) is <br /> Disposal Field (Specify Requirements). 4 <br /> . s <br /> ... .. !Draw existing and required.addition on reverse sidel <br /> I hereby certify-that I have prepared this application and that the.work wiTI be done in accordance with San Joaquin County +, <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: T <br /> -I certify that in the performance of the work for which this permit is issued: I shall not er•.'tplay any penan in such manner as <br /> to become subject to Workman's Compensation laws ,of California." r <br /> / Ownef <br /> Signed / <br /> Title <br /> ,. .,� <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ..— ' ---.-= --- — _--- -=DATE <br /> APPLICATION: ACCEPTED py G DATE <br /> DIVISION OF LAND NUMBER <br /> ADDITIONAL COMMENTS <br /> i <br /> !Y. ��t Date <br /> Final Inspection by: �!� rlts 2;677 ory :(�e 3M <br /> tH ;3 74 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ;e <br />