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FOIL OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> ::.... <br /> ............................... Permit No. 7 ------ <br /> (Complete in Triplicate} <br /> ...-•-•..................•---....._•-.,..__ <br /> Date Issued --•- •-lo�•/s"73 <br /> ----. ---•--_-----__-• -- -- This Permit Expires I Year From Date Issued <br /> --- -- <br /> iplication is hereby made to the San Joaquin Local Health DisWict for a permit to construct and install the work herein " <br /> .saibed. This application is made in cor pliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> D� �- <br /> )B ADDRESS/LOCATI -------• ----._._......__� tt 1. Ci �...-1 -=---- cl:Nsus TRACT ............ �... <br /> Al gun <br />" wner's Name --------- -P .Q........ . .. :oz_L_.. <br /> .......-•-�--•------..__._.:..._..-------.__._..Phone _._._. ..._.... <br /> i <br /> .r-t� -.License # . Phone W lo.'.�.�..6 d . <br /> x*octor s Nome ---------------•----- <br /> stallation will serve: Residence❑Apartment HouseCommercial❑Trailer Court 0 <br /> Mote) ❑Other__.. .-- � <br /> i <br /> imber of living units:----- ---- Number of bedrooms -_->'--Garbage Grinder ------------ Lot Size --------- .--..... <br /> 9ter Supply: Public System and name ------------ - -- ---------------------------- ------------------•----•............Private X <br /> icracter of soil to a depth of 3 feet: Sand 10 Silt® day ❑ 'Peat❑ Sandy Loam ❑ Gay Loans ❑ <br /> Hardpan❑ Adobe 0 Fill Material __--.,.......if yes,type ---------------------------- <br /> lot plan, showing size of lot, location of. system to relation to wells, buildings, etc. must be placed an reverse side.} <br /> EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> t / <br /> kMGE TREATMENT SEPTIC TANK Size__.—mss7.-..AA----------------------_----- Liquid Depth -------------..- <br /> capacity r-�?------- Tyle - -----_ Ma#erial.C..EI of :�-. No. Compartments --2— <br /> ...... <br /> =------- ---- <br /> � t <br /> Distance to nearest: Well _______., ---_._._.....r..Foundation -,__-1--------__— Prop. Line _s_�._:_.._ <br /> i /�/� <br /> ACHING LINE No. of Lines -_-----�__-_------ Length of each line.l�__�----0 ..__. Total Length __16+0___...._..._.__. . <br /> V Box Type Filter Material fW,, ... Depth Filter Material f:k_------_, ---•-_...__..._�.....-r <br /> Distance to nearest: Well ........... Foundation ----/At---------- Property Line.S------- --- <br /> EEPAGE PIT [ I Depth -------------------- Diameter ------._......_ Number ----------:........._,...... Rode Filled Yes Q No ❑rn <br /> Water Table Depth <br /> - ----- ._.____ ---Rock Size - ---------=------------- <br /> Distance to nearest:Well ___________________---__________._Foundation _._---------.---..--- Prop. Line ----------------___.C <br /> :1PAIR/ADDITION(Prev. Sanitation Permit# _.__...,__--__---_ C <br /> ----•------------------ Date <br /> Septic Tank (Specify-Requirements) --------•--------=-I--------------------- - - -- --------------------------------------------------------------.-_-----_------- � <br /> :;_Disposal Field (Specify Requirements) -----------------_'_•-­._—__. ----, ----------------------------------------------..,.__------------- ----------. -_- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -•-----------------------•---- -----------•- -- =--------------------_-_-_-------------------------------------------------------------------------- -----------• -- - - <br /> (Draw existing and required addition on reverse side) <br /> f Aeby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> fir Ordinances, State Laws, and Mules air Regulations of the San Joaquin Local Health District.Horne owner or licen- <br /> C ed iigents signature certifies the following: <br /> `.1„certify that in the performance of the work for which this permit Is issued. 1 shall not employ any person in such manner <br /> "become subject to Workman's Compeosatlon lavers of Callfornia-99 <br /> 4.ned ....__.... - -- -------_.__._._�__ ---------.__ Owner <br /> 'Y. -•-_._._.._�.�{JS�.t__.._ ---...-�-_ --_--•--------------�_...�....--. Title ------• ` - - - - - - -• <br /> (If other n owner) <br /> FOR DEPARTMENT 'USE ONLY <br /> OPLICATION ACCEPTED BY__. _ DATE-_-_.1�-./_,P_-23-----------. <br /> - ---- --------- - ---- -------------- --. <br /> WILDING PERMIT ISSUED --------------------------------------•--------------..__-------•-----_----_-------. ------- ._DATE - .. -- <br /> iADDITIONAL COMMENTS ..-.---------------•-------------------_-•-------------------------------------------------•----------_------------•------------•-------•--------------- <br /> .................•------------------------------­-­-----..-----------------------------------------------------__--_--------------------------------------- ... <br /> ............................... -.._...._-_.... - --- - - -,...._ ...-..._...- - .- <br /> ---•----- ------------- ...................... <br /> _. .._..Ouse .:1 �:: ----------- <br /> -- <br /> ZY <br /> %61 Inspection by. ------- v - -- _ r+c_-----..._............... <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT <br />