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FOR'OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> f-0 r� f --9-f ---- Permit No.__7 <br /> rt 6,i -` (Complete in Triplicate} ---.--..- <br /> ------------------------ -------------------------- <br /> Date Issued_/2_____________ <br /> ----------------------------------------.......---------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Naquiq Local`4ealth District foriauperrbifrto construct andrinStall the,work•herein described. <br /> This application"'is' made°in compliance with Cqu ty O-,rdinance No. 549,ard existingrRules and Regulations , <br /> JOB ADDRESS/LOCATION 7 ��--r��: w _ _95s��i�_ L1-o T� -� __-w--CENSUS TRACT---- - --- ------ ---- <br /> Owner's Name, a---------;..+L1.� ��2 . ( ?' Phone__ .S" --GBf ' <br /> Address------:----_-----------!"-�_4a-. G_ 776,- ' -. z ocf� o '°�Crt o.�r:x Zi 4-� ' <br /> � ... / Y - p <br /> _ I F i 1 <br /> Contractor's Name- -i- � ( orf - # --------License #. 13hone _5?6P - <br /> Installation will serve: Residence [X Apartment House ❑ Commercial ❑ -Trailer Court 0 y <br /> Motel Other-'--------------------- -i- - --- --------- ~. <br /> Number of living units:-----1----------Numliennof-bdroor�ns,­3- [Garbage Grinder_-_Lot Size-.--__�_.'�f+ -------------------------------- <br /> s <br /> Water Supply: Public System an_d name------------- ----------------------------------------------- <br /> ----------- - - -------------- <br /> �y ! _ -- <br /> Character of soil to a depth'f.3.feet; Sand ❑.; Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe Fill Material-.-________I# yes,;type_- f_-__.___. <br /> s = <br /> (Plot plan, showing size of lot, location of system in relation to wiel1's,�buildings, etc. must be placed on reverse side.) <br /> , P?•--------- ------------------- ---Liquid Depth,;-� --------- <br /> NEW INSTALLATION: (No -septic tan.o rs`eepage pit permitted if public sewer is available within 200 feet) 4' <br /> PACKAGE TREATMENT (� ]SEF7IC�TANK Siie_____ <br /> r� �j . <br /> Capacity a00.g- Ype--�,w�Mat�rial ----- ---------No. Compartments--: <br /> 1,4 1 <br /> Distance fib nearest: Wel _ ---------------------Foundation--",,_/__ ------ Prop. Line_-- 4-----_--- <br /> ---- <br /> LEACHING LINE- No:�of,Lirties- -1C.-----------------------Len h of e h line--_4.��--------—---_.Total Length -�/--�-------_----------------- <br /> {' D' Box,-/-/ ---Type FilterMateria ____Depth Filter Material_--_/ ---- ------------------________-------.--__ <br /> Ae <br /> r Distance to nearest: Welo, Property Line.-:-�'` _____- <br /> "' �f r 3.---__ -Number---- ---------,.-4-------- Rock Filled Yese.. No <br /> SEEPAGE PIT `� Depth-._._--.________Diamete __--- .- ____ ❑ <br /> /� . .. . �' - i <br /> Water Table Depth-------1Cr�- --------------- ------------- -----Rock' Size-----/-------- --- --�--/------------- <br /> L, Distance.to nearest: We --- ----------- ----------Foundation--- ----------- Prop. Line.----• -- ----. <br /> l <br /> REPAIR/ADDITION (Prev. Sanitation Permit#---._---------------------------------------------Date------- ------------.----------------------- <br /> ---� <br /> Septic Tank (Specify, Requirements)------------------- --.- .. -- -- - -----------=------------------------ <br /> Disposal Field,(Specify Requirements).------=----------- ------------------- -- --------------------- <br /> r <br /> --- --------------- ------------- = ------------=----------------- <br /> a r (Draw existing and required addition on reverse side) <br /> I hereby certify th9t I have pr4pared this application and Acit the work;lwill be done in accordance with San Joaquin County <br /> Ord inances,'State Laws, and..Rules and Regulations of the San Joaquin_ Local Health District. Home owner or licensed agents <br /> signature certifies the following ' �4 ' "�..�✓ ` <br /> I � <br /> "1 certify that in the performance of the:v�+�rk for which this permit is issued, I shall not employ any person in such manner as <br /> to beco su 'ec kman's Com sation lows?of California." <br /> i �r <br /> I <br /> Signed a 's' �� ° C -- <br /> -------------------------------- <br /> BY------------ ------------ ----------------------=-------- TitIe--� .�- ----------- <br /> _ �- <br /> (if other' than-owner) <br /> \'I F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ _ . - __ 'Z/-27/ 77. <br /> JYC =DATE - <br /> Q. J <br /> DIVISION OF LAND NUMBER--------.-.S--7�--.-�-.-.. -----1------------ -- -=--__--- <br /> ------. DATE------------------------------ ---------------- <br /> ADDITIONALCOMMENTS---------------- - ----------------- --------------------------- ---- ------------------------- ---------------------------- ------------ <br /> -------------------------------- ------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------- ------------------------------------ - <br /> Final-Inspection by:. _ Date =.d'-_5:1v - <br /> - --------------- - ---------------------------------- ------------------- ----- -- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 2�e» 3M <br />