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N <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> i' -------------------------- No._7��` <br /> (Complete in Triplicate) Permit ----------- <br /> Issue _ <br /> •--------- - ----------_ bate______._..___.________._.___..__ This Permit Expires 1 Year From bate Issued d___E'-131-70C_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit t� stfruc�t~and instal! the work herein described,i <br /> This application is made in compliance with;County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION--/ �D�"""�""" -•s= ---w-- - ---="` '_ CENSCJS'TRACT---` <br /> f .. <br /> Owner's Name- ----------- :- ��l'v^ t 9� 4------ --------------------------- <br /> one <br /> d <br /> 3 _ - $ <br /> Address----- ----- ti_ Cit --------- <br /> Zip--- <br /> k -.---------------, �f } License #� Phone_ �fr2 T <br /> Contractor's Name_._. ._ _ 4, :�_ z <br /> Instpllation:will, serve: Residence : Apartment,House.❑ Commercial ❑ Trailer Court'I _, r 1 t, 1 <br /> . <br /> ❑ Other= --------- <br /> Number <br /> ------ <br /> r T <br /> 1 <br /> Number of living units: 1- --_-Number of bedrooms:----ZGarbage G_rinder_ Lot Size__--_ <br /> Water Supply: Public System and'name___________--------------_` __; ___ __-_-_ ---------------------------- ; (_Privates <br /> ------ - - -- <br /> Character of soil to a depth of 3 feet: • Sand 0 Silt ) ( + # <br /> . <br /> � I y_❑ Peat❑ ,Sa.Jdy!Loam ❑ 'Clay�oam ❑ s <br /> ` Hardpan ❑ Adobe's" Fill lVlaterlal__.___ _ If yes, type_: _.- <br /> i <br /> (Plot plan, showing 'size of lot, location of system in relat'io'n we is LhIclings,•etc.'must be placed on r,-verse side.) ­7 -ti+„ <br /> NEW INSTALLATION: [ ] SEPTIC TANK'- g ' S1z�tted if public sewer!s available within 200 feet,)' 0.y <br /> (No,septic•tank"or seepage .pit perrnJ <br /> PACKAGE TREATMENT ,,( Six " i ` -------Liquid Depth._-S_) r�` <br /> �' �` - <br /> Ca 'cit ./ -' ------Type - -- ] \ i <br /> I p Y. _- � ___ Material CI :_No. -Compartments__.- . -- i <br /> Distance.to nearest: Well----- _ _.__ ---------------------Foundatilon ______ 01*_, Prop. Line . :- •_ '� <br /> LEACHING LINE No. of Lin __ _2 _. ,,�q ength of each I-ine.�Z_r -__v Total Length"__. m-�* ______________ <br /> F r <br /> • ` p <br /> .. <br /> D Box_.._ .. Type Filter Mater al_t_-- _. ___._-Depth Filter Ma"ferral-------_C --------------------------,-'--'^"""—'s` <br /> SEEPAG <br /> 'Distancecr�arest: Well i FaundaJlon__ ��_ z ___.._.Property Line . _ ._ I __-----_ ___ <br /> j'� E PIT -t4 'Depth-..ra , -}__Diameter._._ ------i_-_ umber_._ 1---------------------- + Rock Filled YesX No ❑ <br /> �/ [( Water Table,Depth { Rock Size - ---- <br /> Distance,to nea-rest: Well .------_--------------I------:--------------Foundation_ALA)_.-----__-_--.Prop. Line=�- �-- <br /> REPAIR/ADDITION (Prey Sanitation Permit _=---'r---- --- - --- --<_-- _ - --_-Date-'-------_--- •_--- ;-- ) <br /> it <br /> Septic Tank (Specify Requirements)---._ `: ---:-- ----------------------- e . . <br /> K ---------- -------- --------------- -- <br /> Disposal Field (Specify Requirements)--- --- -----------_: ----,----- IiY <br /> - y ------------ ------ ----------------------------------- <br /> --------------------k-- <br /> _. - # ------ <br /> ----------------------_ . -- --------------------- <br /> �.� 6 <br /> ---------- �r <br /> ----- ---- - ---- -------------------------------------- -- <br /> (Draw existing and requrrd gdd,iiop'�on reverse side) <br /> ,s F <br /> I hereby certify thatJ have prepared this application and that the work will be done in accordance with San 'Joaquin County . <br /> Ordinances, State Laws, and Rules and Regulations of- the. San Joaquin Local Health.Districf, Horne owner or licensed agents <br /> ,.. <br /> Sig, <br /> nature certifies the following: ; <br /> "I certify that in the perfo-rriiance- of?the 'work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation: laws..of. Ccilifornia." <br /> ---------- <br /> Signed-- <br /> ------------------= <br /> --- <br /> ---- <br /> Owner <br /> ----------------- <br /> :Tit! <br /> If-other than,owner} <br /> FOR-DEPARTMENT,,USE ONLY& t y 4 <br /> CATIONFA�CCEPTED B ,. *�.- - c. " ' .rl f t . 3 <br /> APPLI, y <br /> DIVISION Of LAND NUMBER.----------- i---------- = = <br /> DATE_:.: - ----------------- <br /> i <br /> ADDITIONAL COMMENTS -------------------------=------------ -------- =--------------------------------------------------------------------------------------- ----- <br /> = = - --------------- --- --- ----- ----------------- ------ ---------- --- - <br /> = -= <br /> # ---- <br /> --_-__`___________________________ _____ ______ ____ ________ __________________________-----------------------___---- <br /> __ ---- _-__ _________---__--__________ _ -. ______--_-_-_.-________---_----.__ <br /> - .} - _ <br /> ----------------------------------- <br /> -------------_-----------------------______ /// <br /> "______i7 _ ___ <br /> Final-Inspection b ---------------------------------------------- <br /> a-_ - Dte K/ _ --'77 <br /> p Y <br /> E!{ 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M t <br />