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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -4�1-3 <br /> Permit No. -- ----•-------•----- <br /> ------------------ ------------------------------ <br /> 4 (Complete in Triplicate) <br /> �.:_...—.;.:t..— , Date Issued <br /> - f ` This Permit Expires 1 Year From Date Issued i <br /> ----------------------------------------- <br /> cal <br /> ------ --------- r <br /> Application is hereby made to=the San Joaquin Local Health District for a permit to construct and install the work 'herein <br /> described. This application is made`in compliance with County Ordinance No. 549 and existingRules and Regulations: <br /> f' t . F <br /> j <br /> J08 ADDRESSjLOCATION K L Q__ROA],,,__PT'Q ---3 1Bs "IIOrt-b---Df----------- <br /> JOB <br /> -B - TRACT --------------•= ; <br /> Owner's Name _.Ind-ependeSIt._�`_aTM-.&--$U-S-i- a s--- !lU ]---------------------•-------- <br /> ----------Phone 415-5620'+73---- <br /> i ----------------------- City .:_Qa1�1A?1d-------------------------------------- I <br /> Address ----9251-,E...-_F-0=t9e lth _ 1 . . <br /> - $35--3--14 <br /> alm u#-S� lumbi SVC. -------------License #�9�-�------ Phone .. � I <br /> Contractor's Name ------------ -�-------------p------ ------ -- ------- --- - - - -- - <br /> 4I k <br /> Residence Apartment House❑ Commercial:❑Trailer Court i❑ <br /> Installation will serve: ❑ <br /> Motel ❑Other _.-Barbecue pat1o__�pri-vate) 4 Toilets 2 lays!. { <br /> OAE_Garba a Grinder ------""-.-- Lot Size ----- ------------•---•--- <br /> Number of living units----3SPP.PNumber of bedrooms -X-.. . 9 <br /> Private. <br /> Water Supply: Public System and name ------- - 6 <br /> `• Peat Sandy Loam ❑ Clay Loam�� <br /> Character of soil to a depth of 3 fee#: Sand❑ Silt❑ Clay ❑ ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If Yes, type ---------------------------- i <br /> buildings, etc. must be placed on reverse side.) <br /> (PI'ot plan, showing size of lot, location of system in relation to wells, l <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public'sewer is available within 200 feet,) i <br /> E <br /> Size._6� 9� ) """ " . Liquid Depth ----64n------�ICTANK�& , ..tt-- ; <br /> PACKAGE TREATMENT­[ ] rSEPT <br /> I <br /> j <br /> 2 ...6� j <br /> 1=71,Ca acit Q Type Pre neastMaterial.__Oc�ncr"ete:No. Comportmen s M <br /> _ 10 --------- Prop. Line ---- r <br /> Distance to nearestF Foundation ....----� ` <br /> ---. "__"-- Length of each line-- <br /> - +tbca---9Q=---- Total Length -------- Qf-. <br /> s <br /> LEACHING LINE [V'--`No_ tof Lines "-fie:-=- tt <br /> ._ i ---- <br /> 'D' 13ox <br /> ---------- Type Filter Material P -�-- Filter Material 9-- <br /> t t - - n ....M� <br /> i , <br /> -- - -.. _ v Foundation '. _ ..Property Lie <br /> Distance to nearest: Wel]"' . ------ - <br /> t, Diameter --- Number ----- --------------- Rock Filled Yes ❑ No.❑ <br />` SEEPAGE PIT [ ] ' Depth <br /> ----------- <br /> __Water Tale._Depth r' �•`;'� Rock Size -------------------------- <br /> = ""-�--- foundation Prop. Line ---------------- <br /> Distance'to,ndare� hlell ---- -- ---------- ' ••"- <br /> ' ' -----1 <br /> ' ).> `�f -------- ------- ------ Date - ------•-------------------- ` <br /> ----------------- <br /> REPAIR/ADDITION(Prey.Sanitation P.ermit,# : -------- <br /> ----------------------- <br /> Tank (Specify-Requirements)-,L----------------------�------ <br /> -------------------------------------------------------------- <br /> Septic <br /> t <br /> ------------------- <br /> ---------------------------- <br /> j Disposal Field (Specify Requirements) "-""-------- --------------•------- - <br /> ------------------ --- <br /> _ ------------------------------------- <br /> ---------=----------------- <br /> 4 �A <br /> ------------------------------ <br /> ---------------------------- _ <br /> ............."--- ------- _ . <br /> {Draw existi..ng and required addition on reverse side) <br /> ce <br /> 1 hereby certify that I have prepared this application andtha will <br /> Local Diistrne-in �t nHometowner or Ih Son cenuin <br /> - <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin <br /> r sed agents signature certifies thefollowing: <br /> "I certify that in the performa}r c`, he work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to W rkman's C mpensation of California." r <br /> Signed -- <br /> PALM UTST p �-N7 _ -- ERVT -,-=----------------------- o <br /> ' ---------- Title _.."Nana-ger" <br /> ------------------------- ------ <br /> ---------------------- <br /> FOR <br /> � (if other than ow f - <br /> FOR DEPAATMENT USE ONLY; <br /> i / '-------- DATE 8r_�-.7v---------------------- <br /> APPLICATION ACCEPTED BY ------------------------------- <br /> DATE . <br /> BUILDING PERMIT ISSUED --------,.--------------------- <br /> -------- <br /> ---- <br /> ---•- <br /> ADDITIONAL COMMENTS --------------------------------------------- ------- <br /> ------------------------------- <br /> - <br /> ---- ------------------------------ <br /> - ---------------------------I------------------- <br /> ------------------- ---- <br /> - -------------------------------------------------------- <br /> Dale - �I:ZQ <br /> --------------------------------------------------- <br /> --------------- -- -- <br /> "-i-------------- --------- " <br /> Final Inspection b ----------------- <br /> SAN JOAQUIN LOCAL HEALTHISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />