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_r <br /> FOR OFFIC��USE: APPLICATION FOR SANITATION PERMIT */ <br /> �'���--9 <br /> i <br /> ------------------ ----------------•-------- ------------ (Complete in Triplicate) _C�.�` <br /> Permit No. <br /> -------------------------- <br /> -------------------------------- Date Issued _S_r�- ----- <br /> This Permit Expires 1i Year From Date Issued _ <br /> ------- --------------------------------------------- zoo^r 0 <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> --------------- <br /> 1013 ADDRESS/LOCATIO ---------/4 vv ------ �------- CEN TACT <br /> SUS R <br /> ---- - ---- <br /> Owner's Name ------- - - LI_ '�-------- <br /> 5-q- <br /> ------ <br /> --------- Phone--- ------------------------ ------ <br /> r --q.��- c-� <J Cit ,LA _Hr C r-----------------------------------------••- <br /> i Address - =,'--- -- 4� --------- ------------------- Y <br /> ------------ <br /> License # - Phone ------------------------------ <br /> Contractor s Name - <br /> :--------------------- <br /> installation <br /> J_- ---- --- <br /> -- <br /> Installation will serve: Residence+Ogpartmen�House,❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Othe�,----------------------------- -----•--- _ <br /> j -- -- '� -- <br /> Number of living units:.____1_--- Number of bedrooms ,________Garbage Grinder --_~--�--Lot-Size _. ____- - lam-- f <br /> f ------------ -1 t^r_ - ------Private L <br /> Water Supply: Public System and name ----- ----- •---- - - <br /> m <br /> Peat Sand Loa0 Clay Loom ❑ <br /> Charatu'r�of soil to a depth of 3 feet: San�,�ilt❑w Clay❑� t ❑ __. Y„ ,. . �:. . <br /> �.,..�..��...�f <br /> 1 Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type <br /> t <br /> (Plot plan, showing',size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (Nojseptic tank or jseepage-pit permitted ifrypublic sewer is availablean�ithi61200 feet,) s� <br /> 1 1 Size-- � rr - '�.. Liquid Depth _._ <br /> PACKAGE TREATMENT [ I SEPTIC TANK�[e �. C <br /> ° ry- �C`No;Compartments f <br /> Capacity -r-'_0 - Type Material �+�� .�..� _ <br /> Distance to nearest: Wel! .------ - �-- --- <br /> --Foundation L'--- ------- prop: Line -- ------ <br /> - /` <br /> LINE [ j No. of Lind �'"^ "Lera� - - l�Q-- tal Toth .-__ - _---- <br /> LEACHING ones � gthof a h�lirae-. � �.''�en <br /> Yp _.De t♦i"`Filter <br /> _ ----•---•- <br /> I � y <br /> 'D' Box ___ _ _ --- e:Eilter Material _ � p <br /> Line _. _._..._ j. <br /> F ,,,.D�s ante to,nearest: Well ------------ --------- Foundation Foundation 1Property T No � 3 r <br /> SEEPAGE PIT [ ] Depth ----_-- I -- --Diameter___: �- _-- Number ----------------- - --- Rock Filled y-Yes' ❑ { <br /> Water Table De th t ------------Rock Size ------ -� <br /> ----------------------------- = <br /> tpi + -Foundation -------------------- Prop. Line -------- ------ ----- <br /> Distance to nearest: Wella___.�------__________i----•----• <br /> REPAIR/ADDITION(Prey. Sanitation Permit# -----------•------------------ Date ---------------=-------- } <br /> ' - <br /> Septic Tank (Specify Requirements) �" - ------- <br /> ------ ------------=- =------------- -------------------------------- <br /> Disposal Field (Specify Requirements) ---------------------i-- -- -•---- -------------------------------- <br /> ---- ----- ----- --- ---- <br /> f� f ---L/S� - <br /> - � <br /> the work will y <br /> --------- ---------- ------- ---- ------=--- ----- ----------- <br /> --------------- --- --- se side}-- <br /> (Draw existing and �equ�red addition on raver <br /> 4 hereby certify that I have prepared this application and that be done in accordance with San..Joaquin <br /> County Ordinances, State Laws,'and Rules and Regulations o!f the San Joaquin Local Health District. Home owner or licen= <br /> sed agents signature certifies the following: <br /> "i certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> CLS to become su ject to Work pensation laws' of California. <br /> Signed -- V -------------------------- --- Owner <br /> __ � ------ Title ------ ---- -- -----•---- ------ ------ ---------- ------ <br /> BY --------------- - -- -e----han-- -- - <br /> {!f other than owner) # <br /> FOR DEOARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ J-- ---.--. •------ - _- - - -------------------- DATE - =I� --_ <br /> -------------------- ------- - --- - - -- <br /> BUILDIN"G PERIViIT�ISSUED-.-------------------------------M. ------- - ------ -------=---� •--- --�D•ATE -=_...-------- ------=-�-------•--- <br /> ---- <br /> ADDITIONAL COMMENTS ---------- --- � C '=i\ ` ``fir------------------------------------------------------- <br /> -------------------------------------------------------------- ----- ---- <br /> ------- ----- ----------- -- ------- ----- ---------- --- <br /> - -------- - ------- --- <br /> - -- - --- - -------- -------------------------- <br /> ,' Finallnspecti - <br /> --------------Date ---- <br /> SAN•JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'SS Rev. 5M <br />