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FOR OFF1>=E:'USt: APPLICATION FOR SANITATION PERMIT <br /> Permit No: -- <br /> -- --------------M- ------ (Complete in Triplicate) <br /> ------------------------------------ <br /> This <br /> --°-- Date issued <br /> ------ <br /> Permit Expires I•Year From Date Issued <br /> ----------------------- ,y i,- <br /> A <br /> Application is hereby made to the Son Joaquin <br /> compliance ec wial Hh•Cou�r%Dtytordinance rpe <br /> m549 and existing Rules tand t Regulations: <br /> rein <br /> described. This application is made p I <br /> JOB ADDRESS/LOCA iON ._-�7��__�_-�-, -`s:--�-�- -�--�� ---=- ---------CENSUS TRACT i----- ---- ----------- <br /> Phone ------ <br /> �+ <br /> Owners NameC -i <br /> --- ---�-O ------------- -- - <br /> ------ ------- <br /> ------------------ <br /> City <br /> Address --- � <br /> Contractor s Name ..___ <br /> -- <br /> rtment Hous <br /> -License # ---------:-------------- Phone ----------------- ----------- <br /> r -- --------a-❑ Commercial :❑Trailer Court `❑ <br /> Installation will serve: Residence l(pa , <br /> E <br /> Garbage Grinder /_Y-C7--- Lot Size ----4--_---- - �'�� <br /> Motel _Other ---------------------------------------------- <br /> der <br /> __-___-_ := <br /> Number of living units:--'---/----- Number of bedrooms i <br /> ---:Private El <br /> of soil to a depth of,3 feet: Sand' € Sil C Peat Sand Loam i <br /> Water Supply: Public System and name ___-__--- --------------- i <br /> ------------ <br /> PP Y• i <br /> ------------------------------ <br /> ------------- ❑ Clay-Loam � # <br /> CharacterP lay ❑ <br /> _ _ ---Hardpan <br /> �� -Adobe❑l Fill Material '____d--_ Y ;type --------------------- <br /> I <br /> g 4 buildings, etc. must be placed on reverse side.) :\ <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> see a pit permitted if public sewer is available within 200 feet,) <br /> NEW INSTALLATION: No septic tank or V <br /> �`' �^ - Liquid De th - <br /> SEPTIC TANK i Size --�X� �--------- q p <br /> PACKAGE TREATMENT [ ] g� C __ No. Com artments✓�-- --- <br /> Capacity Q ©----x Typef`,QE-f-1 _ Material_ C P , <br /> p Y /-t- �� --- Prop. finer-! <br /> . _ Foundation _ -- -----�-- '�------•_-- <br /> istance to nearest: Well -._----_-��-•-- ------ - 6 .�� a <br /> x r 1 -------- Total tengtf► ----;,!-P� ----- <br /> - loj�No. of Lines ------------------------ Lengthof each line--------- <br /> ING LINE <br /> I C - -------- <br /> ---- -- <br /> LEACH ,D, Box Vey_ Type Filter Material Depth Filte i Material ----_-- 7I- <br /> foundation Pr _; = <br /> r. f <br /> . Distance to nearest: Well ------75i <br /> �(�25__. Number ------ =—=-- Rills 111JJJ <br /> SEEPAGE P1T=�[ Depth _1 / !Z ' <br /> Water Table Depth ----s _ ---Rock -� <br /> 'i h. <br /> 1 { '! + foundation �� lr . Lire <br /> to nearest: Well __ ' <br /> #MiRL�00!'l i P;ev <br /> Distance <br /> Cation Permit 9 _ _ Date = ` ; <br /> i -- <br /> ______ `a <br /> • 4(-?-,'e <br /> � <br /> _ __________________________...___-__------.._- <br /> '� Septic Tank (Specify Requirements) ------ --=-------------------------------------------- -------- <br /> ----------------- r X � �r - <br /> ��� 1_ r►-t nrD -----------Vr=B ��------- <br /> Disp�sal 'Held (Specify Requirements) ---, ----------- <br /> s - = <br /> �J s ----- €`' s <br /> ------------- <br /> i !? <br /> ----- - - _ - <br /> ,-,,, (prow ezisting�ii�td,required addition on reverse side) _ - <br /> '""" t ._ v_ Y licaien,-and that the' work will be +e in accordance vvilf+ Sao �oMeia <br /> I hereby certify thafi l have prepared this app „ . <br /> County Ordinisnces,;,State Laws, and Rules and Regulations of the San Joaquin Local HQalth District.ilonte owner or licen- <br /> sed agents signature certifies therfollowmg: <br /> "I certify that in the perfprman of the ark for which this permit.s issued, 1 shall not employ any person in such manner <br /> as to bec a subject 1W ns Co ensation laws of California. <br /> i Signed __ ----- <br /> ---------------- Q`^�ner <br /> f -- -------- <br /> By --- ------------ ---------- ------- ------------------ - <br /> - `fit- Title <br /> (If other than owr%rr,) i <br /> FOR .DEPARTMENT USE ONLY <br /> �{ °------------------------------------- -�------- - - - - <br /> APPLICATION ACCEPTER BY--.- � -_----DAVE---------------'----------=---------------- <br /> "x-------------------------------------------,-- --------------------- -- <br /> BUILDING PERMIT ISSUED ----------------------- -- - ' <br /> ADDITIONAL COMMENTS - ------------ --- <br /> -------- - ----- - - ---- - <br /> _.3_.__.___.' , <br /> _.-___----—_1*-- _ _--_._- - _ _ _________________________.___...__.._ - __.__._-.-__ <br /> ................_...._..._--.._-_.____ -__-._.---__ <br /> _ -___---__- <br /> Date _... ; <br /> Final lnsp :Y.r zz <br /> l SA}_V0AQUIN ,LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M. t <br />