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S- <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit No..� <br /> Date Issued.,,—_g.-_,2- <br /> f ----------- ---- ------- - ---- - ---- ----------- This Permit Expires 1 Year From Date Issued <br /> v� <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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/.LOCATION„_. C��.7_-�- ---- W�CJL-SX�---------wC-._---Mq.!T��.CENSUS TRACT------------------------------ - <br /> Owner's Name V-RNIrF l------ t'!:"-E-/VOq/Al -----11------------ ------------- x)03-t—Phone__..&23----_N'35...---" <br /> Address-.--.--C.. <br /> In <br /> ,.Y�1------------------ ------ -------------------------------------------------------------------City-------------,,--_-----------------------..._Zip------------------------------ <br /> f Contractor's Name-- --��_ C�1(------ ------------------------- ---------------- - <br /> --.__.--License #----------- ----- <br /> Phone <br /> Installation will serve: - Residence Apartment House 0 Commercial ❑ Trailer Court ❑ <br /> . . t Motel -❑ - Other--------- <br /> Number of living units:----- umber of.be rooms.....~Z..---Garbage Grinder....--.-'.-Lot Size......�clra-- 'QE-_ ----_---- <br /> _______________ __ <br /> Water Supply: Public System nd.name-1 -------- ---------- ------------------------ ---.- ----.-..----------.--..---------e-.-.--- :_:,--------------------------------------Private <br /> _. I <br /> Character of soil to a depth cf 3 fe t: ` Sand :Silt E] Clay 71 Peat [-] Sandy Loam EJ Clay Loam E] <br /> Hardpan Adobe Fill Material .._..._....If yes, type-------------------------------- <br /> (Plot plan, showing size of loft, location of system in relation to wells, buildings,'etc. must be.placed on reverse side.) � <br /> NEW INSTALLATION: ;(No septc tank or Je(p7age pit permitted if public sewer is available within 200 feet,) <br /> J� <br /> PACKAGE TREATMENT' '[ '] SEP tlC SANK [: Size.-_---�U--------------------------------------------------------Liquid Depth --- -- ---- -- <br /> Cap city- y -- ype (?,e°------_-Materia)---- '�m�r+ '.....No. Compartments--------- <br /> nearest: Well.:------------ --------------------- ------Fou�n7dation--------------_-----------Prop. Line-.,-------.------------;---. "U <br /> LEACHING LINE [ ] No. of Lines.---.-- 2----- ...._.Lengtfiiyof each li, e,.------------�-------.-------.Total Length.----.----I yU--------------- <br /> 11. <br /> D' <br /> W. .. . B.o..x. .... ._-s--Type Filter Material---- tepth Filter Material--- M�.....11..,..-. <br /> ----------------�------------- <br /> rxFoun aon -------------1--------- <br /> WelDist{ nearest: Property Line '-------- --------------------_--_--`t-_ <br /> -_-_- <br /> bSEEPAGE PIT Depth--- c1m e'�F­0------------ . <br /> Rock Filled Yes ❑ No ❑ <br /> ----- --------- --------- ------------------------ <br /> - ----�- ;.,. <br /> 1 Dist nce.to nearest: Well..............,.: . - �: . ...cFou'ock Size...__._.._...__....-,.. <br /> Wat r Table Depth___:._______ �.-___ R <br /> - ------ <br /> - ------- J- ndation--------------------------Prop. tine--------------------- <br /> REPAIR/ADDITION (Prev. anitation Permit#-- -------- ------------------- _--- . -.Date- ---° -----:------------:'--- ) <br /> Septic Tank (Specify Require ents)----- ------------ I ----------------- --------------------------- ----- --------- -- <br /> Disposal Field (Specify,Re u ilrements) _.-.-.-,-,-.-.-.:-- - ------------------ /E-------------------------------- ------ ------ ------------- ---------------------------- <br /> ----------------- <br /> ----- ---; <br /> ----------- <br /> --------------------------------- �N ------------- = - ----------------- --� - ------ ------------------- - <br /> ---- - - ----- ------------------------- ----------- - - - ” .:: <br /> - <br /> _ (Draw existing and req red addition on reverse side) <br /> I hereby certify that I have prepared this application and hathe✓work aivill—be done inccardance with Ion' <br /> Joaquin County <br /> Ordinances, State Laws, a Id Rules and RegulationsVf the. San Joaquin Lo al Health Dilstrict, Home ow4r or licensed agents <br /> signature certifies the followig: <br /> "1 certify that in the-Perform once of=the work for which this ermit is issued, 2 shall not employ any person in such manner as <br /> to become subject to Workman's Compensation law <br /> s_of Calli_for <br /> I <br /> Signed { ------- <br /> --------------- -- ----- ----Ownex ,y " <br /> By-------------- -- -- ---- - - -----------------------------------------------Title -----------,---- - ------- ------------ <br /> (If other t nowrier} <br /> f . . <br /> ° r QE ARTMEN) U NLY o <br /> _. <br /> APPLICATION ACCEPTED BY ------ �- -=----- -- ----- - ------ - ---DATE.------ 7 --- ----------- <br /> ADDITIONAL COMMENTS - = - -_- .. DATE --- E ------------------------------- <br /> - <br /> DIVISION OF LAND NUMBER -_____- <br /> ------ - <br /> ----- --------- --------------------------- ---=------ = = = = I----------------------------------------------------=-----:---- <br /> ------------------------------ ------ --------------------------- --------------------------------------------------- -- -- <br /> ------------------------------------ - --_-------------- --- -- -------------- <br /> ---- ----------- <br /> Final Inspection b Date--------- -- �/ <br /> P y:- <br /> EH 13 24 JOAQUIN LOCAL HEALTH. DISTRICT r t Fas si711R1-V-.-7-176--3M <br /> tp _J yrs ! ! W-...J �hJ <br />