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y <br /> F <br /> ` OFFICE USE APPLICATION FOR SANITATION PERMIT <br /> y _ Permit No. <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Dote lasurd <br /> r^ !:cation is hereby made t'o the San Joaquin local Health District for a permit to construct and install the work herein <br /> ascribed. This opplica+i:�n is made in compliance with Cocmty Ordinance No 549 and existing Rules and Regulations: <br />"'F ADDRESS/LOCATION 1-5 > cr`)� ~ ,:!',J'<.'I' .:�'::':'� > /1 c! CENSUS TRACT . . <br /> wner's Name l✓��.�' t= .T �C� �.•i`./ .r. '� �;�1' / ` Phone <br /> ddress �JJ J /,lCr I [.!f 1:. , .i _....... ''ity 7l1 "fir' <br /> ontractor's Name Jr.�� License # Phone <br /> staHation will serve: Residence[]Apartment House❑ Commercial ❑Trailer Court [, A <br /> i <br /> tAotel (]Oihcr/Y )b/) . k e j IC.". l ry <br /> umber of living units: Number of bedrooms,! Garbage Grinder J)i? lot Size �`�- <br /> later Supply: P blit System and name . f ity!t k)/.r. .L:!C(/ _ Private <br /> ha atter of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ <br /> Hardpan❑ Adobe Fill Material If yes, type .......... .......... <br /> lot plan, showing size of lot, location of system in relation to wel : buildings, etc. must be placed on reverse side.) <br /> EW INSTALLATION: (No septic tank or seepage pit permitted if public <br /> sewer is avail a within 200 feet,) <br /> V KAGE TREATMENT ( J SEPTIC TANK <br /> Size �/�.�� �� liquid Depth _ <br /> r� Capacity Type Mater�l f Noy Compartments r. <br /> Distance to nearest: Well 10r&X 1ils.t<. ..Foundation/(4 .. ........ Prop. Line .. ! ........... i <br /> nIaIINGLINE O No. of .... <br /> Lines !)/VC length of each line fr Total length 0'4:' <br /> 'D' ©ox v <br /> ^ . Type Filter Material /fi�t C .. ..Depth Filter-Material <br /> Distance to ne�ost: Well, ��rFoundation 1,9 , Property Line .... ... _0'0 * <br />_tErAGE PIT O Depth Diam6ter J ✓ N;imbe• eN 1� Rock Filled Yes)q No ❑ a' <br /> Water Table Depth . ... ......Rock Size ° <br /> Distance to nearest: Well Foundation ron. line ...................... <br /> PAIR'ADDITION(f'rcv. Sanitation Permit # Date . ..... .........) s, <br /> :optic Tank (Specify Requi,ements) <br /> �9r <br /> Di; pcsal Field (Sreafy Roquirements) <br /> _. ................._. ...._ . . . ..... <br /> (Draw existing and required addition on reverse side) <br /> hereby certify that I have prepared this a»rlir.atio and that the work will be done In accordance with Son Joaquin <br /> ou,ty Ordinances, State Laws, onJ Fules -ind P.egulntions of the San Joaquin Local Health District. Home owner" or Ilcen- <br /> rd ogonts signature certifies the following: Y <br /> certify that in the performance of the work for whicl, this permit is issued, I shall not employ any person in such manner <br /> s I.. become pt ble t Vlorkman'r4 Cornpow ntion lows of California." <br /> p , d CJS. Owner <br /> �! Title t+ <br /> (I' other than owner) <br /> r <br /> FOR DEI'[, hUSE ONLY <br /> I ATION A(7r(PTFi) i•'( f1 / ''•r <br /> I•.'.I Ir I' J I)ATF <br /> i i:kAIAL 0A',A'LIJI:, .,.. <br /> It,.l, rt:un by / 1 ` �i ( �L Ls Date 7lC'(�: <br /> f/ <br /> l r 11 P; 10CAI HFALTH DISTRICT <br /> I <br /> ,� T- %R Rry 5'A <br />