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FOR OFFICE USE: <br /> FOR OFFICE USE: �' �1 /APPLICATION FOR SANITATION PERMIT <br /> 77—�4 <br /> t 7 .• i <br /> a ----------_�i.t------•-- -�-------�---- L Permit No..--•-----------•-•• -- <br /> �' :" iComplete in Triplicate} <br /> ---: �4//4 �`-� <br /> �j Date Issued_.G." l <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaqui—W6cli'Mealth;Districts-F•b permit to construct and install the work herein described. <br /> n_is m <br /> This applicatioade �n compliance with County Ordinance No.847 clad existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION..:Z//G4.7."..�-1•r:. .�.J � ?7 /� -"- � `�' <br /> CENSUS TIRACT.,_Qe�............... ..... <br /> jl . �./�. --------- one. <br /> Owner's Name:_._` �.ly��1'_... I .?!JtaT ----------------------------------- <br /> -!Lip- <br /> Address.............. ; <br /> Contractor's Name_ ._..... ....... ...... ........ ......_Phone <br /> License # <br /> Installation will serve: Residence A� use.❑`tmentHoCommercial � { <br /> k a <br /> Trailer <br /> ou <br /> j Motel �,Ot1i}r---= � . .,.. . . <br /> E' Number of living units:..'- .-}_____.Number of.bedrooms-.�...-garbage Grinder .Lot Size.._... ! -,-. ••--•-•••••••-•- <br /> i a ! c <br /> Water Supply: Public System and name. ._._._._...._•. ...:........••_....._..._..: Priv t <br /> ae <br /> Character of soil to a cleoth of 3 feet: Sand ❑ Silt❑ Clay❑ ' Pe'at ❑ Sandy Loam/;Clay Loam Q <br /> _-Hardpan ❑ t-Adobe ❑ Fill Material.. ._`f yes,type...;._._.__ <br /> i - <br /> ?J <br /> (Plot plan, showing size of lot, to ation�of system in relation to wells, buildings�`etc.'must be placed on reverse side.} <br /> r _» <br /> ... <br /> • NEW INSTALLATION'" (No se tic tank-�r see a e it Siretted if iic sewer is available within 200 feet,) j <br /> l t <br /> PACKAGE TREATMENT"[ T": SEPTIC T NK/[ ] ;churl }--• r- --'- -•--••-•E-----Liquid Depth.:---.............. <br /> t ' - - N .: <br /> ' <br /> Ca acitY�1- •� .-.N_ TYPe-.---:"":-._.._-"-. Mate:alS `=---- -------- otompartments-.._..."_!:_. <br /> ..,... . i �Folhda ion...:...:... Prop. tine,Distance,to n1rest. Wll... ._ <br /> ,1.,, <br /> ` LEACHING LINE ['] . No. of Lines;:.-.`.r�'S ' �.. th,of-each line...." �'. Total Length.!­ .:...... ........... ........ <br /> 'D' Box.........:--Type F1a#e ial""�- ---Depth Filer Material_---_._-_--• -•-----�----•-...... j------ U <br /> -Distance to nearest: ,all" 's_:_""— alation--------- ----------------Property Line--------------------------------- <br /> .� Rock Filled 'Yes ❑a .a[] <br /> SEEPAGE PIT [ ] Depth..-_'.._....__..bias dfee'.�--- -:"< ,u Icer_.......... ------ _ <br /> it : - = .Rock Size" ...Water Table Mepth _k---- ••--=---- . ----:.._..........__. rop. Lin <br /> e-------- ----------""""Distanceo �st: ell_f Foundation. <br /> �Jt <br /> REPAIR/ADDITION-(Prev."Sanitation Pte,mit#r....... ---•--- ----------------- 'Oat - •-•---•-------=---- <br /> e- ° } <br /> I .r • <br /> Septic Tank (Specify Requirements).„F j t2•-- .,�. : :i . . <br /> Disposal Field (Specify Requirements)...., .!...._._.-_-.".-._.. . r-- • -`------- <br /> ••---•-•-- . - .......... <br /> ----------------•------- <br /> z existing and'required'addition on reverse side) + <br /> I hereby certify that 1 have prepared this-application and that:the.-work will-be done in accordance cwith San Joaquin County <br /> Ordinances, State Laws, and Rules•and Regulations of the San Joaquin Local Health Distrk#, Home owner or licensed agents <br /> signature certifies the following: ', 1 <br /> "I certify that in the performance of.the work•pil which this permit is issued, I shall not employ any person in such manner as <br /> to becomes ject to Wor an's Compensation laws. of California." <br /> t ._... <br /> Signed. ---- - --.".... .. . . .. ......... -- ----:.._....;Owner _ <br /> BY -: .. -------------- ......-•. e. <br /> .. .. '.Titl t <br /> { other than owner) 1 <br /> f. FOR DEPARTMENT USE ONLY w <br /> 00 <br /> APPLICATION ACCEPTED BY------."-- `---_" 111 <br /> .__.- __ ,rZ .- �8- --•----•---DATE__ +,. i ....................... <br /> !s. :- <br /> DIVISION OF LAND NUMBER.............. ..:.... ° ---- - DATE. <br /> ti : _. <br /> ADDITIONAL COMMENTS............................. <br /> -------• ---•--•----- ----- --- -- ``.., - 7 <br /> �. Final Inspection b ................s.� - w_.Date.O .(7...7--------------- -------••--- <br /> Y -• ..... .................. <br /> �"`""- -- --- f65 21677 REV.7/76 SM <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />