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FOR OFFICE USE: <br /> .....................................:................... APPLICATION FOR SANITATION PERMIT <br /> _ 1:COMets.. ,. l <br /> g p In Triplicate) Permit Na <br /> This Penult Expires 1 Year From Date lssved ©ate issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordincinro No. 549 and existing Rules a d Regulations. <br /> egulations: <br /> �3 <br /> JOB ADDRESS/LOCATION <br /> ........ <br /> Owner's Name .t. L7,f' ............... <br /> /, , TRACT <br /> . _..-------�-mss-�. ��.....---•/�'/..�.�.4-.,� !1�.. <br /> Address -_._... : ..:_ .. aC._. l --...:........:.............Phone ... <br /> ............. •...._..•. <br /> ityf .. / ! <br /> o 's Name <br /> Contract r __.. rr_. .�- <br /> xCI�S'�/.Y?t-�. -. License <br /> •, • Phone .............. ----------.installation will.serve. Residence©Apartment House❑ Commercial JJ1'ra;ler Court 0 <br /> F 1 � <br /> ' Motel <br /> � ,� El Other........................ <br /> =.. <br /> ................. <br /> Number of living,units------------- Number of bedrooms __........._Garbage Grinder <br /> : •--•_....... Lot Size <br /> Water Su - .....-----•----•-----••.................. <br /> Supply: Public System and name ........... <br /> ............................... .......... ...........Private ❑ <br /> Character of sail to a,depth of 3 feet:--•Sand - <br /> r ❑ rSitt❑ "Clay-❑~Heat❑ Sandy Loom ❑ Clay Loam❑ <br /> 'Hardpan <br /> ❑ Adobe❑ Fill Materia! ............ If yes,type , <br /> (Plot plan, showing size of lot, location of system in relation to wefts; buildings, etc. must be placed an reverse slde.' <br /> NEW INSTALLATION: �. + ! <br /> W . (Na septic tank or seepa pit permitted If public sewer is available within 200 feet,) <br /> i <br /> f PACKAGE TREATMENT j ] SEPTIC TANK <br /> X .�. Liquid Depth ...//?-- <br /> .- � <br /> Capacity S._._. 7ype, [ J1_ Material.-C'O(�(�_ .J... No. Compartments �., _ <br /> Distance.to nearest: W Z <br /> . Well . .--,..-�.-----f-.Foundation �i�..f'7 Prop. Line . <br /> ' 1 .. ...�': <br /> LEACHING EINE: }( ] s No. of Lines " 1._:° ..: :..__ Len Length of each .line......_ <br /> l --- g ------ Total Tota! Length ..... <br /> p 'D' Box/—, Type Filter Material ." Depth filter Material <br /> r <br /> 1 i <br /> Distance to nearest:`Well <br /> .._ <br /> •• •rf••-..._ Foundation � .�.._ , <br /> ��---Vii`---. Property Line ...�. <br /> SEEPAGE PI ( ! Depth ........ ....... Diameter <br /> . . Number --------------------- ...... Rock Filled Yes ❑ NO <br /> { Water Table Depth -• •..................•---•-----..._--.... -.Rock Size ----•- ---••--- r <br /> s� J.-~-Distance to nearest: Well <br /> ..Foundation <br /> .................... prop. Line ...................... <br /> REPAIR'/ADDITION(Prev. Sanitation'Permit <br /> _.. -•••-•------••-•---•-....1.........- -.-- Date ................................ <br /> Septic Tank <br /> ---- <br /> Se <br /> P 'jSpecify Requirements} <br /> ............. <br /> Disposal Feld '(Specify Requirements).' / <br /> - -------•----- ----•-----•- f <br /> 4 -----•-•---.. .............................................. <br /> - -- 9 o -----g-a - •- -dd. i. -----....e . e.s-- .e.).......................................... ................ <br /> ' {Draw existin and required addition on.reverse side) <br /> I herebycern that I,have-prepared this application and that the work will be done In accordance with San Joaquin , <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Loco <br /> t Health.Diatrict. Homo owner or liven- ; <br /> sed agents signature certifies the following: P� <br /> "! certify that in the performance of the work for which this permit is issued;t shall not employ any person in such manner <br /> as to becom subject to Workman's Compensation laws of California.w .. <br /> Signed._ ._ .�� - G <br /> 1 BY -..._.. fir.-tea - f� <br /> Owner' <br /> _ -------- ---� ' ---.- Title _.... f; <br /> ` t <br /> Iif.other than owner! _ ------------------------ ....... <br /> f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY '' C <br /> . l3L1ii_DlN0 PERMIT ISSUED .--------------•-__-- . . . <br /> ADDITIONAL COMMENTS -- --------------- DATE .- .................. <br /> - .---------•-------------•---...__._......_.. <br /> ------. •-- -------= •-------•--• ........I—— •...............I._._...__. <br /> •-------------------•-----------.,._.......---•------ -•--------------------• --- --------............................................ <br /> ----------------------------------•-----------.._.......... ---------- ----------- ------ <br /> final Inspection by: ----------------- .----------------- <br /> --------------------------------- _. JJ <br /> --••-•-•---...-•--•-......._... ? <br /> EH 13 21; 1-6Z3 iv, 5 15 Date -..- - _-�? <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ......................... <br /> ISTRICT8/ ... 3M <br />