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+ - OR OFFICE USE: r <br /> `=--APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> -.-' <br /> p" ��!-aa <br /> : --- ------ -gin Triplicate) Permit No.. -- ----- - <br /> .. ---- -- "---- This Permit Expires ) Year From Date Issued Date Issued____---------------- <br /> Application <br /> ______ __Application is hereby made 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 /> JOB ADDRESS/LOCA TON—,/ <br /> _ (Af r /7/,,a - G / O �.CE <br /> N S TRACT Owner's Name �0 /.E �!0 x <br /> ---------- - --- ---- <br /> i , �. <br /> lfy _ <br /> Phan -Addresss°b 3b ` v -- <br /> _ ------------- iyw ! 566ontra[tvr' Name_:__.___.' ------- <br /> -------------------------- - - - ----- - <br /> JL <br /> License # <br /> Installation will se,ry Residence j - ---- - <br /> - Phone_ <br /> + ; # ❑. Apartment House Commercial Trailer Court <br /> 1 t v .... . Motel- <br /> El ❑ 1 <br /> Other.-•.�. R.f3:i_ni-=- � - ---Ma/3i�:/�'dM F}' <br /> 1. . I - - __ .. .+ <br /> Number ofhving unitS_____ _________Number.of.bedrooms._ __-_Garbage Grinder__Na_--{.Lot Size.__. _ G2Ff <br /> 1 r1 ! r <br /> ` ----------- <br /> Water Supply: Public System.'ansi'name-- / �✓. f�c1D4 LA'-r'ry i'✓G`` <br /> ----------------- <br /> --------------------- -Private ❑ <br /> ,.-.:,.Chpra ter of soil to a depth of�3 feet: Sand ❑ Silt❑ Cla <br /> Hardy'" Y ❑ Peat[] Sandy Loam Clay Loam ❑ <br /> .--' pan Adobe. Fill Material__.. Ifest <br /> Y . , type--------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION.1 [/ No septic tank.or seepage ' ' <br /> ! � pit per if public sewer is available within 2' <br /> PAdk�AGE TREATMENT - SEPTIC TAN..K -[;1' - <br /> , <br /> feet, <br /> Size-----3Z00 <br /> _ ------------ Vq <br /> ----- ------ ----=-- --Liquid Depth- ----- <br /> Capacity__.__--`:----- :'-------- <br /> ---------------- <br /> � � <br /> ------ <br /> ' ` : Type ---------- ----Mate,rial----- -------- ---------:-No. Compartments- --L1� <br /> _. Distance to naarest: Well___.,/_®O. F �; <br /> it / r <br /> LEACHING LINE 6 , " -------- ------Foundation_.. •Sd Fr-----Pr Line-. ----------- <br /> [ 'Na. 'of Lines,_L-'Z1 `c l Prop. L n <br /> i .9th of.each line._ <br /> f f g 9-Q------------- <br /> ., <br /> ---- <br /> Length <br /> th.-- <br /> - <br /> Pox <br /> --/?Q FD' k1 Tpe Filter Material______ Depth Filter Material._____ <br /> -DistW ------------ <br /> --- y <br /> --- <br /> a <br /> :re ._ /_ _U ' Foundation <br /> tion J -v --"-r" -PropertYLine_-SEEPAGE PIT>. [_].— <br /> ------ <br /> Depth.:--------_ _ ,£— iameter <br /> . __Number------------------ ----- <br /> Rock FillecYes ❑ {No} . <br /> � Water Table'•Depth__--�--:------•----____-- _ <br /> --------------- -- ------Rock Size--- ------ -------------- <br /> Distance to nearest: 1NeiL. YA---------- ----- " _ <br /> ------ ------.Foundation_-: :f. <br /> - a <br /> REPAIR/ADDITION (Prev. Sanitation Permit#._..___ ___ ________ --- Prop, Line._._______----:-V------- <br /> r - --Date ; <br /> Septic Tank (Speci.fy_Requirements)=-___:____�_` : \- -� -- - <br /> } # , . <br /> --=----`----------------- <br /> -------------- <br /> Disposal Field (Specify1Requirements)' 1_____..__-._ - --- <br /> -------------- , <br /> ----------- ----- - <br /> ---------- • ---- - <br /> ---`--L j------ _ - - <br /> - --- -- ---. ---- ------ - --- == . ------------- <br /> . _._ ________Y <br /> 0_17 -: - ------------------------- <br /> --------------------------------------_----------_---- <br /> I <br /> t (Draw existing and-rrequired addi#ion on reverse side) <br /> I hereby certify that I have prepared'this application-and-That the work will be dome -in accordance with San Joaquin County <br /> Ordinances, State !Laws- and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: l <br /> "I certify that in the performance of the work;For whiefijKis permit is issued I shall not em to any to bec subject to Work P Y y person in such manner las <br /> ensation laws'jof••.California." <br /> Signed �' <br /> v---- --------------------------- ------- } p p� ! <br /> -------------------- ---=--------- -------- ----------!---Title--- <br /> t other than ownelrJ l --- - ------------------- <br /> r F <br /> 0 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _-___ !. - <br /> DIVISION OF LAND NUMBER.---- 'Q-------- ---- DATE, <br /> ------------------. ----------------- <br /> - -- ------------------------- <br /> -= ------------- ----- <br /> DATE --- .......................... <br /> ADDITIONAL COMMENTS ---- ---' -------- ----------- <br /> ---- ---------------------- <br /> ----- <br /> ------------ - -- <br /> ----- ------------- <br /> --- ------------ <br /> _ - --------------- ------------- <br /> Final Inspection b --------•---------------'- --------------------------- <br /> ------------------- <br /> -------- <br /> ---- -------- _.._ - _ <br /> ------ ----------------------- -----•- ate-- ------- ----- - "- <br /> EN 13 24 � - - --- �------ ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 21 s» Rtv. 7 76 3.M k <br />