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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------ --------------- (Complete in Triplicate) Permit No.77=..1� <br /> ...... .... ..................... GG <br /> Date lssued._7.—r ?7 <br /> -%�This Permit Expires I Year From Date Issued <br /> ---------- ..... <br /> --------------- <br /> --- <br /> NNI-1 q <br /> 'H ------�)SIS. <br /> co-tc— Uct an& <br /> a, <br /> 5� <br /> Application is hereby made fo ihe,Soh - oi. al. gallth,Dipstiri�for�o pi�rmit to cont iZt4ill the work herein described. <br /> , w' County <br /> -6tions: <br /> This application is made in c4nn"Plionci 0 t 6rdinaince No.549 and e'xi.sti V®Ru Rule ncl'R�bul <br /> ... . .. ... _J <br /> CENSUS TRACT. ------ ------ <br /> JOB ADDRESS/LO. ATION_...9 ------- ---- ----- <br /> .................. <br /> ..................... ....... <br /> Owner's I . ...... ............ ... -.,Phone---- <br /> city----------- ....... ------zip <br /> /... . ...... .... ........................ ------------- <br /> Address....f. <br /> D <br /> Contractor's Name---- -------....... -------------------License #,(, , <br /> -----7 R-- <br /> Installation will,serve: Residence Ap tient House Ej Commercial Trailer Court,-Ie <br /> k 1 4 \7" -CIA- <br /> ti�IT L- Other.-.. <br /> .......... ......... <br /> Number of living units:................Numbef.bf.becl.Gms...\,5...Garbage Grinder------------Lot Size...... - ---------- <br /> a t I vJ/*........... ........Priva <br /> Water Supply: Public System.-and'narne.._:............. ........................... ;,-.:.•--..----•-••---------•--".:_._ ......... --- <br /> Character of soil to a depth of 3 feet: ' Sand 0 Silt F <br /> I :Clay 0 Peat E] Sandy Loom t CGy Loam-4 <br /> Hardpan [] Adobe E] 'Fill Material............ if yes,type................. ...I-------- <br /> (Pl6t plan, showing size of lot, location of system in relotic�n to wells, buildings, etc.must be placed on-reverse side.) <br /> 4A_ . <br /> NEW INSTALLATION: '(Nonseptic tank or seepage 'pit-permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ 'I SEPTIC'TANK 77, ----b4luitl'Depth-- ------------- <br /> --------No. Compairtm6nts..!- <br /> ------ '-Material <:--------------- <br /> :Distance to nearest: Well-:--V.0__0_-. _----------.........Foundation,._ ­...-Pr6p. Line.._.--____....._.-_— - <br /> LEACHING LINE. No. Lines....'.,..._�2 .........L.Length of.each-Ii ?`"-.{_-,..Total Length..' ----------------- <br /> . ........ <br /> j, <br /> 'D' Box_:__...:..Type Filter Material.------------------ Depth Filter Maierib -------------------_------- ........................ <br /> Dista: rito to,nearest- Well_. Foundation._-_._.____________________..Property Line.......--.-.----------- <br /> -0......Foundation.------ <br /> Depth$U/PA6�rneter---- ........... ....Number----------V--—-----1___'_.*--- ock Filled Yes, No E] <br /> t. or <br /> Rock S'i; L ............ ................ <br /> Water Table ----------- <br /> Distarice:fo nearest: Well .. .................. . Found ati on.. -----------_ ......Prop. Line.--------------.._.._.-'--- <br /> REPAIR/ADDITION <br /> ine--------------- <br /> REOAIR/ADDIT10N (Prev. San itaticin-Permit-#........ ...................... D .... --------- <br /> ---------- - ---------- ........ ---------------- -------------------------------- <br /> q u i re ir�e nts)--.- w.�.-- ­... - <br /> Septic Tank (Specify Re .............. <br /> Disposal Field (Specify Requirements)*.. ................................... .........................---•---_...._ I.....)................. ..................... <br /> ------­------ ------_-­------ .................................. . ...... .V............. <br /> .................... -----------------T..... ..... <br /> ........................................ .............. .......... ......................................­­---- --- ------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have-prepcired this application and that the work will be done in aecorda ce with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of'the San Joaquin Local Health District. 40me owner or licensed agents <br /> signature certifies the followings' <br /> "I certify that in th-6'performance of"the work foi which this permit is issued,:I shall not employ any pirion in such manner as <br /> to become su6iect to Workman's C ensation, laws of California.". <br /> --------- nor <br /> Signed-- �P_W <br /> -------------------- <br /> BY-1 <br /> ------ ---- ........ ----­--­- ---------------------------- <br /> .. .... .. ...Title.._ <br /> ---------- <br /> r an owner)' <br /> fDE TME T US <br /> EONO <br /> BY -------- <br /> L .­ -----C-k................ --DATE--- <br /> IN 7=`7---=--- <br /> APPLICATION ACCEPTED .*LO------- -C4 <br /> DIVISION OF LAND <br /> ...............................DATE-----_------- - -- ----_----- ---------- -- - <br /> '1DITIONAL COMMENTS..._..... .. ----------------------_---_-------------------_---- ---- ........ ----------­--------- ..................................................... <br /> ---------------- .............................................. <br /> --------------- --------------------- --- ----- - f ------ .. ............................................ <br /> ---------------------: - ------- ---- <br /> -------------------------------------------------------11-----------.................................. ---------------_------ <br /> -- <br /> ----------- --------- ........_.................... ------------­------ -­-------­­-------:......I.................... <br /> ------------ --------------­--- ------ .... <._.. .. ..�............-- <br /> -7-4 <br /> Final Inspection by:.. ......!�.......................... ................................. F&S 21677 REV.7/76 3M <br /> EH 13 24 N JOAQUIN LOCAL HEALTH DISTRICT <br />