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110 <br /> ` ..i�.._..�. OR OFFICE USE: <br /> FOR OFFICE USE: 7r �. • <br /> t APPLICATION FOR SANITATION PERMIT" <br /> Permit No...77-. <br /> _ <br /> ----------------------- -------------------------------- <br /> - <br /> (Complete in Triplicate <br /> ------ ---------- Date Issued./1.`- 77 <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. <br /> This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> , <br /> JOB ADDRESS/LOCATION. 10.P�_G::-- -------- CENSUS.TRACT ' <br /> Owner's Name- -- -- -- Li .. ----- °- -- 1 <br /> j k <br /> y=' , Sc�. . t,�_Iry -- city. _ d_-A?l _ _ # ` 3 <br /> Address. � �' ��-- � <br /> � s P 3' <br /> - .__ License #'+ <br /> Phone - --=� - - - <br /> Contractor s Name_'._ f`A� �_L1_G �- <br /> Installation will serve: Residence yj' Apartment House.❑ Commercial :Trailer Court [I <br /> ■ 4-Motel ❑ Other._ =----------- ------ ... <br /> "i <br /> -Na"mber of-living units:._ rNumber_of_bedrooms _'� _____Garbage.Grinder 1ot�5ize _ -r-- <br /> r <br /> ' i i , ..),'(7 i .---- - ---Private ❑C <br /> € n <br /> Water Supply: Public System and_name-. ------ .-.-----=------------ 1---,---_-.--------- ✓��: i U <br /> f Peat ❑ Sand Loam . Clay Loam ❑ <br /> Character of soil to a depth of 3 feet: f Sand ❑ Silt❑ Clay ❑ Y <br /> Hardpan❑—Adobe ❑ - Fi1'I Material_..._-,------If yes type ------------- <br /> j ., r , <br /> (Plot plan, showing size of lot, lacatibn of system lin rekati-6 -to-wehi, bui.ld-ings;'etc..must be placed on re Jesse side), <br /> 3 NEW INSTALLATION: (No!septic tank-or seepage :pit permitted of public sewer is available within 200 feet,) <br /> ;] + t <br /> PACKAGE TREATMENT"[ ] SEPTI-C-ANK—[' -- Size_ <br /> >_�ix-_�1 ------Liquid Depth. <br /> Matanal —--` . Compartments. - •r <br /> t Capacity -. ...Type __' . .. T N <br /> t - --- <br /> __ o <br /> to nearest: Well ;.--- ------------ <br /> ..Distance --- '"'Fo ndationL'--- ----- ---- Prop. Line--------. - - <br /> 0. <br /> LEACHING LINE [ ] No, of Lines. --- -.:'--._- �Length f each I�ins.-. �----_ .- --��_-------Tota- Length ------------------- ----- ---------- <br /> fs f -------------------------------------- <br /> type - <br /> i .. <br /> � l ,. ,.p..l <br /> R D' Box_ __..__- Filter Material---- - -- ---------Depth Filter Materia ----- <br /> • to-nearest: <br /> Well.:-- : ._ -Fours dationM_ = a, -,_ i <br /> ## t <br /> #. ...� + ]. . Property Line. <br /> • - <br /> -Dist anca to-Weare <br /> f ! ----- <br /> l r <br /> Depth kk '� `-- _ _ ---- '• Rock Filled Yes ❑ No <br /> SEEPAGE PIT [ } p -- iometer.---1--f- --- _N#tuber------------} ;_-- --_ - � � <br /> .� -_" -Roc Size-- --------------------------- <br /> [ . AWater Table Depth--- -- 1 ---- . <br /> . s ' _. <br /> Distance toKnearest: Well..- --- ------�'�.-- .Foundation------ ----- p. Line--------------------------- <br /> Distance <br /> ----------- ------ --- - <br /> I �. i <br /> [ ) <br /> REPAIR/AADITION (Prev. Sanitation.Permit#�.-�3�.•S=-�=1--- �7--�-- <br /> S O ; <br /> '10_'�_a) -C:� �3) -Date:= � = '_1' : ------------------`------ ---- <br /> Septic Tank;(Specify•Requirements)._- - ------------. ---- - -- �-i7- <br /> I f4 ------- ---------- <br /> Di'sposal'Field {Specify.Requirements}_--:---:__-,__ < `T -fC.------� �- - --- <br /> i _ ------------ <br /> ---------- r ----- - l ------------------------- -'----------- . <br /> ----------- <br /> T`�."' ----- <br /> f I Draw existin and re i <br /> } I- t -�A ' S g q'uired addition on reverse side}: <br /> I hereby certify that 1 have prepared this:application and that'the work will be done in accordance with San Joaquin County <br /> 1 aws, grid Rules and Regulations of' the San Joaquin Local Health District. Hame owner or licensed agents <br /> Ordinantesf State L <br /> I <br /> signature certifies the following: `` a <br /> "I certify that in the performance of the work for which this permit'is issued, I shall,not-employ-a!y person in such-manner.as <br /> to becomesu "je� Wor mans mpensation-Itiw•s,of_Cdliforiiia..' .._..�� �..-- -•. <br /> Signed '- _ <br /> i -- - • --- --- ----:Owner <br /> . . <br /> ---- ----- -------- <br /> ByA-- I,-----=-- ----t ---=------ -----------�-- -------------------------------:------ --- Title --- <br /> (If other thanf owner) <br /> [ 3.. ' OR DEPARTMENT USE ONLY <br /> DATE I- <br /> APPLICATION ACCEP#TED BY-`_--- <br /> - . <br /> �4--/4------- ---------= <br /> DIVISION OF LAND NUMBER.------ --- -k------- --------------------------------- -----�__ <br /> ----- .DATE- •--- ------ _:.- <br /> _�-_. __ �— --y <br /> ASDITIONALCOMMENTS--------------------- -----------------.--------------------- ------------------ - - _ <br /> ~'� -� f, e -------- --------- ------------------------------------------- ------ ------- <br /> ------- , <br /> -------------------------------- <br /> - <br /> l <br /> , ----------------------- ----------------------------------------------- <br /> Da -- A­.- <br /> 'by: <br /> Final fns ectionLOCAL HEALTH DISTRICT a <br /> s 21677 REV. 7/76 3m <br /> E14 13 24 SANJOAQUIN <br />