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td FOR OFFICE USE: <br /> v <br /> `� OPFI � USE: APPLICATION FOR SANITATION PERMIT <br /> - - - Permit <br /> -------------------- --------------- -- (Complete in Triplicate) <br /> 4 �' �' s70e�.7W"F "� �e Date issued <br /> t <br /> This Permit Expires l Year From Date Issued <br /> t to the <br /> Application is hereby made to the San <br /> Jwi huCountyLocal <br /> Ordinanclth pel$No. 549 antrict for a d exist ng R Iter and Regulatruct and ions: work herein described. <br /> This application is made in compliance , y.., =_ _;W. y , <br /> TRACT ---------- ------- <br /> CENSUS C - 'I <br /> JOB ADDRESS/LOCATION-----------' .. A--- --- Phone <br /> Name. 1�I '_ <br /> ..... .:-- -- -- - <br /> Owners " _ ._ .�' - ----- --' <br /> I -- City . "r?iP '. <br /> ' <br /> Address- ------ -'-.--- ----" � ��f�'- -L`- -- - '-' -'- -'---- ----_-- - '-- ----*' --' . <br /> 3 ct . <br /> License ---'-- PhoneLd.l�"••. <br /> Contractor's Name- AV* iA#0"*r-'�-- -' <br /> � F Trailer Court, <br /> ❑ r <br /> Installation will serve: i Residence Apartment House ❑ Commercial ❑ <br /> - t. Motel ❑ Other . -_ <br /> Number of living units:--s_-___.�_-.---Number_of bedrooms"...J--.--.Garbage Grinder*- -�L-ot�Size-�-'�. <br /> 3 7$ns 190 1 <br /> _' _ _; - <br /> ------------------------------------------------------ <br /> Water <br /> -- --------- ---' . --------------- : nvat <br /> P e <br /> ' Water Su l : Public System.and name-------------"---- -------- I # <br /> pp'y Sand Loam Clay Loam Q <br /> Character of soiV to a depth of 3_feet: Sand El ❑_Clay ❑ Peat❑, � Y�, © <br /> �. _ 77 <br /> t ::. . Hardpan ❑ Adobe[ Fill Material. ... .. ..1f yes, type <br /> - - W <br /> (Plot plan, showing size of lot, location of system in relation to�wells, buildings,.etc, must be placed on reverse side.) <br /> .: <br /> k NEW INSTALLATION (No septic tank or seepage pi# permitted if publie'sewer is available within 200 feet,} <br /> ' Size_:_ � --= -�-���-- -=. �- -.Liquid Depth ---'�---`�------- ------Q <br /> PACKAGE TREATMENT\L ] SEPTIC TANK t�p1 t P <br /> Capocity_.1_9-�'0----- TYpe-----=-------------- --Material =w Noe Compartm is 4 ' - <br /> r , <br /> Distance.to nearest: Well---.1-d.0-0------=---- --------- -- -=Foundation-._._�-Al-- --=-----Prop. tine -- -- .-------- <br /> �, f <br /> LEACHING LINE [�(} No of Lines,::--.- .:----:Length of each line..- ` --,--- ------ .Total Length.A. - -------= ,' <br /> . I ---- -- ---------------, <br /> r 'D' Box ----_�(-_--Type Filter Material .--j-�� `----Depth Filter Matenal _1_ �... <br /> ---; Property L1neC s <br /> Distance to nearest: Well _-�x.37. .- -Foundation. .. ---- p Y <br /> : Roc e ❑ N <br /> SEEPAGE PIT ( ] Depth ----Diameter Number----------- <br /> Filled <br /> ` r <br /> '._ ` Rack Size `---------- -- ------------- - <br /> ------ <br /> k FiVI --------------------------- <br /> ----------- <br /> Yes o ❑ <br /> { <br /> r Water Table.Depth ---------------- - � <br /> i <br /> k .... -------- <br /> rr "Foundation t -- <br /> - Prop. Dine <br /> Distance.to nearest: Well. - -- s <br /> -Date. _..-. <br /> }} �' <br /> REPAIR/ADDITION (Prev. Sanitation Permrt#_.;--"'----�- -'-- -- - �--------f'-- ------- x � � ---------------------- <br /> Sep-tic <br /> --- -- --Septic Tank (Specify Requirements)._ -),t- -d" _J�_� - ---- �8 i <br /> Disposal Field (specify Requirements) --------r <br /> r - -;; - <br /> 3 <br /> - - --- --- -- ---' (Draw e-xis#ing and regyi.red addifion-on reverse side} <br /> be <br /> oaquin <br /> I hereby certify that I have prepared this application and thhetSan .loci uinlLocaldHealth District Home owner orone in accoracince with Son Jlicensed agents <br /> t i <br /> Ordinances,. State Laws; and Rules�and Regulations of t � q .i.. --i.• - � <br /> signature certifies the following: <br /> :.-- -:-�s i o person in such manner as <br /> "I certify that in the performance the work foc which this permit is issued,—]shall not employ any <br /> E to become 's ect Workman's compensation,laws of California. s t <br /> Si ned ---- Owner <br /> R <br /> g <br /> -- '----- Title <br /> 4 <br /> g" "------------- --- '-----------------�---- .. ---- - - .. F <br /> If other than owner) ! € <br /> FOR DEPARTMENT LVE ONLY -.- <br /> `. PATE ------ - ' <br /> ---------- ---' <br /> ----- r <br /> APPLICATION ACCEPTED BY---- �= - - - ----------- - -- <br /> DIVISION OF LAND NUMBER "-_-------;;:--- <br /> -------------------=- <br /> P <br /> ADDITIONAL COMMENTS--------------------------------------- --------- ----------- <br /> - --------- -------- --------- ---------- <br /> ----------------- <br /> - <br /> ! - <br /> - <br /> } •--------- - <br /> ---------------------------------------------- <br /> Inspection b --- <br /> ._ ._ . -.---------- Date. <br /> Final Ins <br /> p y= ----- -- - - r&S 21677 REV. 7/7�6 9J <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ((40, <br />