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i <br /> FOR OFFICE USE: I I FOR OFFICE USE: - <br /> APPLICATION FOR SANITATION PERMIT <br /> IComptsta in Triplicate) mit Nom/Cr3 U <br /> This Permit Expires I Year From Data Issued Date Issued//-J.�.7lT <br /> 4pplication is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> this application is made in compliance with County Ordinance No.549 and existing Rules and Regulations. <br /> r <br /> 'OB ADDRESS;LOCA ON ;:06/19 -e' V.fU-z-I��'� �'�� CENSUS TRACT ._.... .. _.__.... ..... <br /> Owner's NamerssG+- -s-c _ Phone _ <br /> 4ddress 1 v-+-- - +--- fry city 4 i- I* '-7ip <br /> Contractor Name ��jLeL.a -7�r a.(!G�/ <br /> .,ll---+ !-� �-r+ License A �-�z" Phone <br /> InL <br /> stallation will serve: Residence Apartment House❑ Commercial❑ Trailer Court ❑ <br /> Motel ❑ Other <br /> Vumbw of living units: 1. Number of bedrooms Y Garbage Grin,:x ..Lot Size- . .. .... ..... . . _. <br /> Nater Supply: Public System and name _ _.._._. . ... .... .. . _. . _ _. . _... ... ......Prhmfe Irl . <br /> -haracter of soil to c depth of 3 feetZSond❑ Silt❑ Clay❑ Peat❑ Sandy Loom❑ Clay Loam❑ <br /> Hordpon 7� Adobe❑ Fill Material If yes,type <br /> Plot plan,showing size of lot, location of system ;n relation to wells,buildings,etc-must be placed on reverse side.) <br /> 4EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 400 feet,) <br /> rACKAGE TREATMENT ( I SEPTIC TANK [ I Size ..__ _. . Liquid Depth .. .__.. .. ... <br /> Capacity Type Material No. Carnoartments __....... .._....._ \' <br /> Distance to nearest:Well Foundation .. ._ .. Prop. Line ._..._ . ..._.__...� <br /> EACHING LINE [ I No. of lines Length of each lino Total Length <br /> -D" Box Type Filter Material Depth Filter Material . _. .. . .. . _. ._ .... ......... <br /> Distance to nearest:Well Foundation Property line ..... <br /> iEEPAGE PIT ( J Depth Diameter Number Rock Filled Yes p No Lj <br /> Water Table Depth Rock Size . . ... .. .._. .. .. <br /> Distance to nearest: Well Foundation Prop, Line _ .. <br /> IEPAIR/ADDITION tPrev-Sanitation Permit V Date J <br /> iephc Tank (Specify Requirements) ✓/ a __ <br /> ]rsposal Field [Specify Requirements) �yr i --�0 OdA'0.fL� <br /> ...........h��L/ .9-.cc.E f.� ct. . / . .3.3',r.zS ' U <br /> __... <br /> IDrow existing and required addition on reverse side) <br /> hereby cMify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> )rdinances, State Laws, and Rules and Regulations of the Son Joaquin Low; Health District. Home owner or licensed agents <br /> ignature cerMHes the following: <br /> '1 owft Meat In the perfermonca of this work for which this permlt is Issued, 1 shall not employ any person In such mans as <br /> o become subject to Workman/s `Compensation s o} California.' <br /> iigned 'd �///i Owner n <br /> iy_. ___. . . .. N..SJ' isle <br /> [if other thon owned <br /> FOR DEPARTMENT USE ONLY- <br /> ----- <br /> 1PPUCATION ACCEPTED BY /' fo' <br /> DIVISION OF LAND NUMBER / ... DATE <br /> \DDITIONAL COMMENTS _.. . ._. . <br /> ;nal Inspection by: Date <br /> e <br /> Is>. SAN J LOCAL HEALTH DISTRICT rss tr V,sev.zr»an <br />