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M FOR OFFICE USE: . <br /> -FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No.. ----- - <br /> --------------------------------------------------------- (Complete in Triplicate) <br /> Date lssued_....� :_--» <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District <br /> 549 and existing Rult.ruct and install the es and Regulations: work herein described. <br /> This application is made in compliance with County Ord a _ _ _. _ ._.i...� <br /> '--------- '---.CE ---------- <br /> --.,---.CENSUS TRACT =----- ------- ' <br /> JOB ADDRESS/LOCATION._ -.--. -:F. <br /> ---------------- -------- --------- -` Phone__ 5=-------- 'r <br /> Owner's Name. --------- <br /> city--- <br /> • __. -.----------------- <br /> -7 <br /> . ------- - .. - 1 .. <br /> ® <br /> Address_ �� PlyZip <br /> . f <br /> = .�a.� - -----License-#_ _ _Phone-­�-�-� -- -- <br /> Contractor's Name--W-- ----- y - _ � <br /> i J •-~Traile <br /> - Corrimercial [] ❑ <br /> Installation will serve: Rest enceApartmenf House.❑ <br /> otel_F_�---Other I <br /> - I 1 <br /> = _ -- -- - e <br /> Number of living units: __._____Number of bedrooms_-_7___-.Garbage Grinder--- Lot Size_______________ <br /> ` ------------- --Private <br /> Water Supply-. Public S stem and name-------------- - ---------------, }------- <br /> pp Y: Y . <br /> Character of soil to a depth of 3 feet: Sand ❑ 'Silt❑ 4 Clay❑ Peat ❑ Sandy Loam [] Clay Loam <br /> Fill <br /> Hardpan EJi ❑ Material=- - <br /> ----If Yes, type-------------- - ------------- <br /> Adobe <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] I ; <br /> a ` it ermitted if public sewer is available within 200 feet,) <br /> NEW INSTALLATION: ;(No septic-tank or seepage p' p 1 E Liquid Depth._----------- ----- <br /> *SEPTIC TANK [:] P=Size__ :_ --- --- <br /> Material_ No:�ompa�tments. 1 _ 4 <br /> PACKAGE TREATMENT Capacity) °Q' YPe ��. - <br /> 1 _1 oundation._if _ ------= - `---Prop. -Line------------------ <br /> _Distance to.near.est:.Wel.l.-__"/e�_--- - - <br /> r ---- -- <br /> ;Len th of ea'cFa�lina.-_7 .r Total Length., .J . . <br /> LEACHING LINE_' [ ] No. of,Lines._-_---- -- g <br /> -------------------- <br /> 1 D' Box I.- <br /> --------- Type Filter Material__ x---Dept1 Filter Material . �__:_. <br /> ... � - �:.. Wr me <br /> Distance to nearest: Well__-_-___.___ "-- 4 Foundation__._ -------- <br /> t <br /> - ----Property L' l� <br /> r .. ;{ ! ­ I,-_+. r_ -a, .._r `` Rock Fil Yes❑ No <br /> PIT [ l Depth_ .._. - <br /> ----Diameter-- --------- <br /> SEEPAGE ---- ---Number _ =--- <br /> 5I <br /> ( - __ <br /> Water Table Depth. - _-.Rock S1z !_ L <br /> 3 o ntdation- -Prop. Line <br /> " Distance to nearest: Weil.'..... -- : <br /> - '- -----------------Date--------- <br /> 'REPAIR/ADDITION (Prev. Sanitation Permit - - ----- 3 I ---- ; <br /> 5eptic Tank (Specify Requlrements)-- -::--- ` --•"-=--------_--------------------1-=--y- ------ - ----=-- =------ -------- ---------- -- <br /> = - --------------------- <br /> { Disposal Field (Specify Requirements)`-:------ -----------= - ------ - -- -----------------:-------------: - <br /> " I .. _ ----------------- -------------- <br /> ------------------ <br /> ----------------------- <br /> --- <br /> --------- - <br /> k - ------- - .- <br /> ------------ <br /> ------------------------ <br /> :. <br /> = -------------------------------- _ <br /> - ' <br /> ---------------------- g q# <br /> (Draw existin and re ltd addition on reverse side] �n { <br /> k <br /> I <br /> n County <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San-Joaqui <br /> Ordinances,, State Laws; and Rules:and Regulations of; the. San Joaquin Local Health District, Home owner or licensed agents <br /> v <br /> signature certifies the following: <br /> _�.�-_.-• ` mploy any person in such manner as <br /> "1 iertify that it the performtxn e f the:wark for which this ermit-is-issued, 1 shall not e <br /> to 'become subject to <br /> Workman's mpensation_aw of. California. <br /> f <br /> r� Owner <br /> �/ t-: <br /> -�- •- -- - ---------- <br /> Signed--- ------- ". <br /> r/J <br /> H / --------- <br /> Title <br /> ` _,. <br /> _. ((Bother than ownerf <br /> FOR:DEPAR ENT US ONLY <br /> APPLICATION ACCEPTED l3Y'--- -- ,-, -- <br /> ----- <br /> ---=-- DATE.- .-------- : ------------- - <br /> DIVISION OF LAND NUMBER_________________ = <br /> ------ <br /> ADDITIONAL COMMENTS_-------------------- - -------------------------- --- <br /> ------------------ -------- <br /> : s.t -----'---------- <br /> ---- ------- - ------ "- ------------ <br /> - -------- --------- ----------------- <br /> ----------- ; ---------------------------- -- ------ --------------------------------- <br /> ty - ----------------- <br /> --- <br /> ----------------- ------------ ---Date - <br /> - � = <br /> Final Inspection by:-__:.- � F8S 21h77 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />