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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT ' <br /> =---------------------------------- ---- <br /> (Complete in Triplicate) Permit No.._.7 _.- <br /> Date Issued._-3.:i-?-_7 <br /> ----------------------------------------------------------- This Permit Expires t Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District;for,a permit to construct and install the work herein described. <br /> This ap'p.fication is made in compliance with,ZCounty Ordinance No. 5 9 and�exisfirig ufes and_Regulatians: �. 5 <br /> JOB ADDRESS/LOCATION I!_� _..stJl!/Lon---------- - �__.�CENS.USI.RACL--------,-------------------- <br /> Owner's <br /> ----- ---- -Owner's Name------ - ------- ----- 6 --tam 8--`0-- <br /> . ._ - .� .�'a=e/-���: ----- -------------- ---.Phone-. , <br /> Address---t------------- ME--------' ---- ---- '-- --- ---- ---- ---- --------------- ---City- -- ---- - ter- �i --------- -------------------- <br /> Contract <br /> ------------------- <br /> Contractar�'s Name. /Q = �-------- --------------- ------License #4 --� �-. Phone- , i 3 f <br /> Installation will'-serve: rt Residence gr Apartment House ❑ Commercial ❑ Trailer Court ❑ i t <br /> Motel ❑ Ot er------ ----------=------ --- <br /> Number of living.units:-_1-----------Number of.bedrooms._.- ______Garbage Grinder-------------Lot Size------------------------------------------------------------- <br /> Water <br /> g_.-.-_-.---.-_-----.Water Sup 1y: Public System and name I ..�4--------------------------------------------------- ------------- - ------- - Private' <br /> Character of soil to a depth of 3 feet: Sand El silt <br /> F1 .Clay f❑ _ Peat ❑ Sandy Loam j' Clay Loam ❑ <br /> i l Hardpan ❑" Adobe ❑ Fill Materiall------------If yes, type_._------ '--- <br /> (Plot plan;,showing size of lot, location of system in relation t wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTILLATION:'"- F[No septic'tank".or seepage pit p re miffed if public sewer is available within 200 feet,) 4 <br />} PACKAGE TREATMENT [ "j SEPTIC TANK [~.] Size---------------------- _�- -------' "" "Liquid Depth ___-4 ----- <br /> t,. <br /> i Capacity.. = 4 ;TYpe-. Material-_ -_ -r—._No:Compartments------- ---- ------------ - <br /> 1 : <br /> ' -- '._Prop. Line F <br /> Distance to nea est:�•�Vell- ) i .- Found'at'ion -j _---__----- <br /> LEACHING LINE [ ] No. of Lines.------- _-_.LLe4h of'each line __---- -^ -,- x-,,-_Total- Length ------------------- ------------------ C <br /> ?. -. y�; : ii ---:Depth s t. ,, .; ljs <br /> � D' Box T >r Filter Material Filter MateriaL�, <br /> SEEPAGE PIT De th____-.__ __ Diameter. --- --__. Number ����-cam- --- __ xogertR lk Filled Yes <br /> Distance to nearest. Well-r_____-.-_.______,___Foundi6 ior}- -----'-----A-._.t- ------------ <br /> 4 M - = .. , <br /> l Water Table De th---- --=----- Rock Size------- <br /> Drstanceao nearest. Well-� I oundati n_-V- __ Prop" _____-i'- ------ ----- <br /> _ <br /> REPAIR/At DITiON-{-Pr ev:•Sanitation Permit#---,' <br /> ---Date _--------�-j- ) r <br /> Septic Tank'{Specify Requirements) _ -., .- -- _---l-_1 °= �"' <br /> r ; == <br /> E � t�� F <br /> Disposal F1x'eldl(S ecif Re uirements ;---------s "'�oF¢)_C--h__ / lG4-- - ------ ------€--- --,------- <br /> ---------- <br /> ------ -. <br /> ! p v q )- --- ,6 u� pa ` _• <br /> --- _ --------!...... <br /> , . ! _ n_i'--------------------------- �__ ----__ l �'„r Je+w 1------------- _ -------- _---------------------�--_ --------- <br /> X1, <br /> -------- _ <br /> 1 <br /> . . _ X1. <br /> - ------ ...._ Draw ------------------------------k--4-------------- � I t-------------' -i <br /> -------- ------=---------- <br /> .^� ( existing and required bddition on reverse side) O�rj V p <br /> 1 hereby certify that,I�Lhave prepared this application and that't9L- 1work will be-d-T one in accordance tth San Joaquin County <br /> = <br /> Ordinances State Laws, and Rules and RegulafionsCo�F the'�'San.-Joaq,uin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify tKatt it! the_performanie of_'the work for which this permit is issued, I shall not employ-any person in sul manner as <br /> to become subject toy or an's ompens tionlaws-of California. <br /> . -_----. = .- -Owner <br /> II � I <br /> B -------------- - -------- <br /> - - --------------'-------------------------------------------------------- Title---------------- ---- - --- -------- --r--------------------------------- <br /> If <br /> ------------------ ------ <br /> If other than owner) E <br /> �IOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED. BY -------=_="=- ---------- ---------------- ---------DATE- <br /> I DIVISION OF LAND NUMBER---------- - =-------------'--------------------------------------DATEE <br /> k -- -----_ ------------------ <br /> -----------------AQQITIONAL COMMENTS =-- -- - - ------- <br /> r` I iAi f <br /> i <br /> ' <br /> �Fina ----------------------------------------- <br /> - - <br /> 7 f <br /> l Inspection bY - --- -- --------- - ` ---------- <br /> ---------- <br /> EH <br /> EH 13 24 SAOAQUIN LOCAL HEALTH DISTRICT Fas 21 ISO. 7/76 3M <br />