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FOR OFFICE USE: 4 <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT p� <br /> Permit No.-7- --------- <br /> (Complete in Triplicate) 1 <br /> Date issued...3-~f-- <br /> ---------- <br /> -------------- --- ---- ------ ------ - <br /> ______-_-___ This Permit Expires 1 Year from Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Li <br /> I <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: jg�f k <br /> �� - om <br /> -.CENSUS TRACT--- ------------ <br /> - <br /> JOB ADDRESS/LOCATION`--.-J-- S f� ! <br /> Owner's Name------ _ 3 -- --- ---------- --------- <br /> -- --------------------- --- <br /> ->'a- - <br /> -- --- --City----- Zip- <br /> Address- -------------- ------ -- <br /> - k- .. <br /> / L:__Phone G <br /> E --------- License #_-n2 - <br /> Contractor's Name--- _ - --- <br /> �• 1 ' Commercial Trailer Court ❑ } <br /> artment House.❑ ❑ <br />� Installation.will serve: - _ _ ____ ----- <br /> Number <br /> __ <br /> of bedrooms:.---- --__Garbage Grander•- <br /> . <br /> k of living units:--- ---------- .Number <br /> Motel-n- -----=------ -- "�------ ---- <br /> • -------:-Lot.Size =_ = --- --------- ----=------ �. <br /> l Number g s s j - - - <br /> ---------- - - <br /> --PriN76te. <br /> Clay Loam <br /> Water Supply: Public System and_;name_-___1---------------- --- ---�,..c.�--.�--�-- --�----s ,�-�• <br /> t <br /> Peat Sandy Laam�Q e Y, am <br /> F Character of soil to a depth of 3 feet: , Sand ❑ Silt❑ Clay ❑ i 0 ~ <br /> +. ._. ._ Adobe ❑ Fill Material ..--If yes, type - <br /> ;Hardpan ❑ ; <br /> (Plot plan, showing size of lot , location of.system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> r see a e if permitted if public sewer is available within 200 feet,] <br /> INSTALLATION: - ",(No•septic flank o p g p + <br /> j - ---Liquid Depth.-------------- <br /> N <br /> SEPTIC TANK ['] Size,----; --------------------------- <br /> PACK NGE TREATMENT 11 _ <br /> p -.:-No. Compartments <br /> . .. Ca aci Ob --Type-)'�� -Matar ial - �--� ----- --- p ---- ------� - <br /> p +�f <br /> ------ --Foundation._-��.----- ----Prop. Line--•---------=-------------- <br /> pistance to nearest: Well--,.__-�dd---- E <br /> � i - Len th of each line <br /> No. of Lines.: ;::-- <br /> LEACHING LINE' [ 1 .-�-_--------- -. g <br /> - t, ' <br /> J iy <br /> ' 'D' Box- Type Filter,Matenal:__rf - Depth-Filter Material--- .__ .;- -- -.--- -- � , <br /> l Distance to nearest: We11-__ .__ 3--- Foundation .- -Property Line ---------- <br /> Distance <br /> _ -- N <br /> - -, •" �--------- <br /> ------- <br /> Roc Fill es,K . o ❑ <br /> 4... SEEPAGE PIT [ ] Depth__.�11'-----Diameter---f------ ------- Number-----------------------,------ _ <br /> ----- -- <br /> _..lRoc Size -j----'-'--- ------- ------- <br /> Water Table Depth---=------;--------------------= - <br /> ® _ Foundation--------- ------- --------Prop. Line F <br /> Distance.to nearelst: Well--._� .___. } <br /> ' ---- Date- --------------- ------=- -------- ----- ) <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------- --=-----=" <br /> ---- --------- "' --------------- - <br /> Septic Tank (Specify Requirements)------------ <br /> --------------------- ------- <br /> Disposal Field (Specify Requ-firemen s ---------------- =' <br /> F - ------- -- - - - ---"-. <br /> ---------------------------- ----------- --- <br /> - ------ - ----- ----------- -- <br /> - <br /> -------------------------------- <br /> - ------------------------------------------------ <br /> �" )Draw existing and required addition on reverse side) <br /> be done in accordance with Son <br /> I h reby certify that I have prepared 'this application <br /> sand <br /> of,the San Joaquin that-the llLocal.Health District Home owner orJliccquinnsed ag nts <br /> tion <br /> Ordinances, State Laws, and Rules and Regula <br /> 4 signature certifies the following: s ' <br /> "I certify that in 'the perFormance:of the work for which this permit is issued,-11 shall not employ any person in such manner as <br /> L to become,subject. to Workman's Compensation laws .of California." <br /> t - -- Owner <br /> Signed--,-- .-----.- -------- --=------- -------- -- ------ - - ----------------------- <br /> Title' - ------------ - --------- <br /> {If other than o ner) <br /> # FOR'DEPARTMENT USE ONLY <br /> �. ; <br /> ` . ..g DATE ----- - --�--- - ---��--- -- - <br /> E APP - - ------ ------ ------- ------- ------- , <br /> APPLICATION ACCEPTED By__--.�.' <br /> --------------------- ---- ------------------------- ------- <br /> ----------- DATE <br /> DIVISION OF LAND NUMBER.------------ ---- :--_---.------------------ <br /> -------- <br /> k - _______________--___________--__ i <br /> ADDITIONAL COMMENTS_..---..------------------------------- --- ---- ' <br /> I ------------- ------------------------ <br /> ---------------------- <br /> =---- - - -------------.---- <br /> - <br /> ----------------------------------------- --------------------------- --------------------- <br /> ---------- <br /> ------ ----- <br /> --------- ----------------- <br /> ---- -- <br /> ----------------------------- ---,.� � '� ------ Date_"---- ----- <br /> Final inspection b <br /> y:---.---..� F&5 21677 REV. 7/76 3A <br /> t EH 13 24 SAN JOAQ IN LOCAL HEALTH DISTRICT <br />