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FOR OFFICE USE: -v FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERM..- <br /> -------- -•------------- ------� -..-.. -...-•------- 7..�-�Q..�_.. <br /> (Complete in Triplicate) Permit Na..,, <br /> Date Issued./- <br /> ...........•..................... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the Son Joaquin Local Health District for a permit to construct and.install the work herein described. <br /> This application is-made in compliarce with County Ordinance No. 349 and existing Rules and Regulations: <br /> r , <br /> JOB ADDRESS/LOCATION....I �Q--_ -... Ll6TTGE ----- <br /> ------CENSUS TRACT'------------------....-.-._._-.. <br /> Owner's Name.... . x STE/�C1�E//?'lE _ -_.. <br /> Address- = /vlE7 TGE. ;i Phone... <br /> �L <br /> = ---------------------------------- <br /> ----------------- <br /> Contractor's <br /> z <br /> Contractor's Name....... i�R�?-/5 ....................................r --......License #_+�_ •fT------__ ..Phane 6- 9 p. •- . <br /> Installation will serve; <br /> -� Residence Apartment House ❑ Commercial ❑n �Tra+ler Court:❑ <br /> Motel. ther099f.Z#Pc4.K.s.'_._ffOt/SE"`k E;s>i t �J <br /> �. }1y rr/Q�rT <br /> Number of living units:."---.1 _--."_Number of bedrooms_.-- - Garbage Grinder _____...__Lot S" <br /> Number .. ..-_._._._____............. .... <br /> Water Supply: Public System and name...................__. _ - -- - private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam E] Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material...:... -._If yes, type................................ <br /> (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> f NEW .INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> ,a � o <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [t.]�` Size ------ -•-.---•-----•.------- -Liquid Depth...:_s_-..a---.-..._--- <br /> 1 Capacity. gOQ........Type---R4�Gr......-.Material-----GOA/C.-------No. Compartments---------z'................... <br /> r e , <br /> Distance to nearest: Well--.--------SO ..�------- ---------Foundation---- �.. ' "........Prop. Line-----`5---'--------_.-- <br /> LEACHING LINE r g �}O g . O r <br /> )� No. of Lines..............__---.._...___.Len Length of each line-_---- --------------•---.--. Total Length _....__.••;�•-----.--------.......__� <br /> D' Box....✓..Type Filter Material 5/R. --Depth Filter Material.------------ $ �� <br /> So S-}-. _ <br /> StlrriP <br /> Di ce�to nearest:Well . .._._.. __. _.Foundation. .'fp __- "�Pioperty`Cine....... ........ . . .............. <br /> i.. 1 ' ' _' W k•5 i <br /> p ! - Number-=-'--------------------------- ��. Rock Filled Yes No ❑ <br /> I1,K Depth 1p. .Diameter...... -... <br /> XB X/o Water Table{Depth._... Rock Size..__._.1`�_X. Z- <br /> Distance to nearest: Well."..-----.SQ <br /> ------------ ...........Foundation......�d__.. ......Prop. Line._--- --.` ..--_-:--. <br /> REPAIR/ADDITION (Prev. Sanitation Permit.#-----------1,-':��.......................Date.-------��,---------------------------------1 <br /> Septic Tank (Specify Requirements) W -'.j-�------------------ ------------------ --------------------------w <br /> ---------------/------ <br /> ---- <br /> ----.. ------------- -.._. <br /> Disposal Field (Specify Requirements) -' .. G..G! �E'E7" K /�,--.Z?f_E,�.... f''._. !/ 5 ��fcy'_.._/'I -•GUi .... <br /> -RE �AG�� �. ' !'v wr�4 /LSP_... :_.7f1` .. /t6Y....B. T�rt.J.... uJ.EJ <br /> r^^ is / <br /> > QcU't/f �ee{:.4 se ''�i ✓ - -Cy :.'.... _ r< ------ <br /> r:' .W <br /> (Draw existing and required addition on r er,se side) {{// <br /> I hereby certify that I have prepared,this application and that the work will be Bonen accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules. and Regulations of the San Joaquin Local Health District: Home owner or licensed agents <br /> signature certifies the following: <br /> "I cert( that in thework �� "� <br /> certify performance af'the ;fot which this permit is issued, t shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." :p <br /> Signed..... ----- . --- x.... .....--4--•- ;Owner { <br /> By........... ---A -- - .. <br /> Title ST/ !!ct 77>. <br /> (If other than owner) ILI <br /> f <br /> 61L POR D PARTMEN U E ONLY <br /> APPLICATION ACCEPTED BY �� `�` - ----------------------- DATE --- .... �9.. ._7. ..... <br /> DIVISION OF LAND NUMBER._...._..... DATE <br /> ADDITIONAL COMMENTS.. .._.... -­------------------ -------------------if ----- <br /> _ a. , <br /> r . . <br /> ------------ --------------- --------------. :---------------- ------------ -•---••---------------------------• -- --------------------------------------------I----­------ <br /> ---------Final Inspecs;on by------ Date..777/_ .._...... ----- <br /> Eli 13 24 SAN JOAQUIN' L WEALTH DISTRICT O ras 21677 REV,17 96 am <br /> i <br />