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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------ ------- --------- ------------------------- -rirpji,ccife) <br /> (Complete in <br /> -------------------------- - ------------- --------------- "O-i F-\ Date Issued --- <br /> -------------- This Permit Expires-1-Year From-Date Issued— <br /> Application is hereby made to the an Joaquin Local Health District for a permit to construct and install the; work herein <br /> described, This application i ma in compliance with Countx.; Orclin6nce No. 549 andL elisting Rules End Regulations: <br /> A-Cf. <br /> J <br /> -----._.__.._CENSUS <br /> --------- <br /> ..............—i- - k <br /> JOB ADDRESS/LOCATION ------------ k-------- ------ ...CENSUS TRACT --- -------- <br /> Owner's Name ----P-09-" -AA ------ h <br /> ----------P one <br /> y5---j-.47 Q 'K <br /> --------- -------- -------- ------------ <br /> Address -------- ----------------------- --------------� Ot -T - <br /> 1 -11 ,- jL j -03V'R <br /> Contractor's Name --- ------- -------/ - _t - "- ic6nse # --- Ph6ne ---4_`- ------­----- <br /> - -- ----------L <br /> Installation will serve.. Residence F] Apartment House-E] Commercial Orai.ler&rt '-,F] <br /> 0.?/9 Fx,, <br /> Motel F-l Other -----------------i------1k-------------- 3t <br /> Size 1,57-- X---- <br /> Number of living units_____________ Number of bedrooms ............Garbage G7eincler ------------ Lot <br /> I Al t <br /> Water Supply: Public System and name ---------------- ---- --------- ------ -----PrivateX <br /> --------------­I----------- <br /> Character of soil to a depth of 3 feet: Sand' Clay 0� "Pw�ta, -Sancly Loam L0�m 1;1 <br /> ' �'T_Hardpan F-1 Adobe,] Fill A�clter+ial If yes;type -------- ._,._-_l------ <br /> (Plot plan, showing size of lot, location of system in relatio9'to wells-.buildings; etc. must b!,,-p(ciced on 'reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if. publit sewer is available with-in 200 feet,) <br /> PTtC TANK:[ I `-------------- ------------------ ------- Liquid Depth ----------------------_--- <br /> PACKAGE TREATMENT [ I SE SiTL,e 1 <br /> "1Noy e -- ----------- Material----------------------1 Noq Compgrtmants 6------------ <br /> ------------------- Typ <br /> Distance to nearest. Well --- ------------ --------- o-Zin-d—ation ------------------- ------------ --------- <br /> o <br /> LEAC14ING LINE No. of Lilies _t-!fL----------------- ength of each line otal- tengt -------------------- <br /> ------------------- <br /> -D' Box ----- ---- Type Filter aterial .......... --------AD I?. Mate iol ------- -------- ............ <br /> Distance.to nearest: Well ------ ------------------ Foundation --------------I------ - Property Line J---------------- <br /> C <br /> SEEPAGE PIT Depth Diamet ------------ Number'-- - _---------- Rock Filled ,Yes 0 No 014 <br /> I- -------------- <br /> ---------------- <br /> Water Table Depth ----------- -- --------------- ------ Rodk Siz6 <br /> t ,,- - <br /> Dista <br /> nce zf__ Foundation ---:1 -------- Prop,., Line ------------- ------- <br /> Distance to nearest. Well ----- -- ---------- .......... <br /> I - k '7 <br /> REPAIR/ADDITION(Prev. Sanitation Permit F# _----------- ----------- - - --------------- ---------- < <br /> -------------- Date,/ <br /> Septic Tank (Specify Requirements) ------------------------------------------ --------- -------- ------------------------f--.f_- -/- <br /> --------- <br /> - <br /> I A'�7 <br /> ,!ga P-ILI c, if— f-J,---- ---f.,. _-C <br /> 'Disposal Field jSpecify Requirements) __2N_E:_i1J---------------- ------------- --- -- ------------ <br /> 25---- ----------- -------------- ------------- <br /> -------------F------------------------------------------------------ <br /> i -:------------ <br /> edladditiot-n �h reverse side)i <br /> (Draw existing and requir .,� -1 t <br /> ` <br /> 1 hereby certify that I have prepared this application and that thework, will be done in accordance ce.4rclancel with'San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San J4;oq6in Local Health-District. Home owner or licen- <br /> sed agents signclllurecertifies the f . Ing: <br /> PT e <br /> "I certifyil/the Perforrnanc 0 work for which this peymit:is issued, I shall not employlany person in' such manner <br /> as to come s bjec. 0 Wo rn;� *�mpensation laws of California." <br /> Sign ------------------------------ Owner <br /> By ---- ---------------- ------ ------------------i------------------------------- Title --------------------------------------------- ---------------- -------- <br /> (if other`othan owner) <br /> FOR DEPARTMENT LISE.,_ONLY_f <br /> -Z7-- 7 Z----":, <br /> BY --------- ------I----------- -------- --------------- DATE .... ------------ ------ -------------- <br /> APPLICATION ACCEPTED ----V.-At-V------ <br /> 77�77_715ATE--- —---------lk <br /> PERMITISSUED ---------------------------------------------------------------------------------------------Z� .", % \ ------------- lk <br /> ADDITIONALCOMMENTS ----- -------------- -------------- ------------------- ------------------ ---------------------------------_-------- <br /> ----------------------- <br /> ..... --------------------------------------------------------------- <br /> ........ . --- -------------------- --- ------­ <br /> --------------------------------- --- --------- <br /> .............. --- ---- -v T'----------------------------------------------------------- --------------- - <br /> -------------------------------------- ---------- ------------------------ <br /> ............ ---------- ---------------- ------ <br /> _____________________________•------------ - ------- --- -------- -------------------------- -3--- <br /> Final Inspec -- ----------------------------Date --- -------------------------------- <br /> --- --------- I <br /> SAN JOAQUIN LOCAL AEXC-TH- DISTRICT <br /> E. H. 9 1-'613 Rev. 5M, <br />