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i <br /> FOR OFFICE USE: <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT I �B 99,(Complete in Triplicate) Permit No,. ._ .. <br /> ...,..- .......�............................ <br /> . � .......................... Date Issued_.Id�/-�$ <br /> i This Permit Expires 1 Year Front Date Essued •. •. . <br /> t <br /> Application is hereby made to the San Joaquin LocalHealthDistrictafor a permit to-construct and install the-work herein described. <br /> This application is-made in compliance withC�`dunty.Ord nabce;No'549 and existing Riles and Regulations <br /> JOB'ADDRESS%LOCATION. ...... .. ,-- -, �........ TR <br /> � C ��. <br /> .. - <br /> � <br /> Owner's EN S. . <br /> -,_ �' <br /> Phone- <br /> - <br /> _. --- <br /> Addresa.,7 1 ! . <br /> _ • ~Cityi .. Zip . 1:• <br /> Contractor's Name. -:.... ----�� <br /> --------------- <br /> License # 1- _../Phone <br /> Installation will serve: Residence Apartment House Commercial ❑ Trailer Court f <br /> j <br /> Motel <br /> - ❑ Other... ....... :......... ...- ,•..........._:_ / _. '. <br /> Number of livingk nits:.................Number of bedrooms._-_.Garbage Grinder.';......°..Lot,Size/•.,.-. �. L �.S 1 <br /> Water Supply: Public System and`nanie_ -,........._.._, " <br /> - .. te <br /> _-. <br /> Character of soil to a depth of 3 feet: '• Sand ✓Silt(] Clay❑ Peat L, Sandy Loam ❑ Clay loam n04 <br /> ' y Hardpan ❑„ Adobe [� Fill Material'i .iQkif yes;ttYP + *� :'- <br /> . <br /> � <br /> (Plot plcr, showingtsize of lot!�locat orsof• tem`i n'rela�ion'to"well""bu ldings, .'must be placed on reverse side,) r , <br /> NEW INSTALLATION.i (No =e ti'c tan,�Y.-.� eep ge pit permitted if public sewer is available within 200 feet,j <br /> PACKAGE TREATMENT e <br /> SEPjIC'TANK � �1 '_..: _•. -- --Liquid Depth.. _.t......... <br /> - _ <br /> ( Size - __ --_ _ <br /> ---• TYPe.... .- ...... •.Materia / No. Compartments. P <br /> capacityt k�%� '' __ ...� J <br /> - Distance to nearest:lNell..,11-.2n _________ <br /> ..............Founldotion..._ _-/ ......._.__Pro Line._. <br /> LEACHING LINE �: (� ' ) C� <br /> Er7� No. o. L nes. ...-...�J. Length of each line._.:_, 4.. .;.....jotal Len th.. la _ F <br /> D' BoxJr� _Type Filter Material.-..................Depth Filter M1erial. -��►.•....-: --_ -•--- <br /> - � F <br /> / , # rty <br /> 401 Distance to nearest: Well_:1 �� Line.-/-/J j /' S <br /> -.._ Foundation................: .Pro e _ <br /> SEEPAGE++PIT .yf c r P R k .. :.._.. <br /> 1. ( � l Depth. .. oc Fill � Yes[� N <br /> Diameter._.................Number r_....:..._ _---- <br /> Water,Tab�e.,De th.- -_ ed <br /> f <br /> P - �--•----•--- -..__ ---- ;_...Rock Size--............... <br /> - -•---•.........:............•.-.•�•-----•--t <br /> 0 <br /> ! Distance'to nearest: WeI0 ..."..._ ./` <br /> - -•:_..... Foundation.. .".Prop. Line <br /> ........... <br /> • <br /> REPAIR/=ADDITION Prev. Soni a~tion Permit#'0,rpw..........._k_, ............._:Dae.................................. t <br /> Septic Tank (Specify Requirements)..._ .,_.... :.... ............._--- Y <br /> ... }.............. -----.......,--.................................... <br /> Dispos.dr�iefd (Specify Requirements)-)--.-_.._.,... #••,_,•, : f <br /> ._ .... -- --............ ........_....I........... _....._ . <br /> _...._. <br /> .. .. ! i <br /> {D;raw;exisfingt�nd requ red:additao n reverse si1.de)�_� - E <br /> I hereby certify that I have prepared lth s oppt cation and that- he work will be do e• in accordance, with San Joaquin County <br /> z t .. .- '„- F r 3„ <br /> Ordinances, State Laws, and Rulesj and Regulations the %San Joaquin Local Health District-'Home owner or licensed agents <br /> signature certifies the following: ; <br /> "I certify that in the performarice of;the,woFrk'for w CYhis'permit is 'sued, 1 hall not employ any person In such manner as <br /> to become subje t,fo Norkallin <br /> Si n ..... _ <br /> ...... ... �. . <br /> f ij ;j� ��-✓ caner _ [ <br /> BY .-... ....:.•.......:.........>{ _,c _ �............... e <br /> itl .....:... ...................... .......... I <br /> (If other thah o-rierj•. `�~ � <br /> t - FOR'DEPARTMENT•,lJSE ONL Y—- -• <br /> APPLICATION ACCEPTED BYE : ,` <br /> � ........DATE- <br /> - - <br /> DIVISION OF LAND NUMBER 'aG ' .`O �1.�-`V.�.7`,fs:�•.-� -- +.. -� �-DATE' . � �7.`.... .. . l <br /> ADDITIONAL COMMENTS...-._.................... . .. J 0 _.................._...._....... ...... <br /> .. . 7 - -....:.... ................... . <br /> ....................�_.-_.. .-_:......:....................... . <br /> -...................................• .................................... <br /> ------------------- --------- <br /> Final <br /> -----_.Final Inspection <br /> .-=. <br /> - r...._ ------------------------------ <br /> ----------------- -----------------•--.----._..-__-----.. ......._.�. . . . <br /> .t <br /> . <br /> -.p-- .:� - <br /> :H is za ..........................•---_..... .._........... Date_. ' - .......7e... ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV. 7i76 sM <br />