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x . <br /> FOR OFFICE USE, FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No.--,: F <br /> {Comp}ete in Triplicate} <br /> ----------------------------------------_ _ Date Issued.__��__�. <br /> -- <br /> .: <br /> ................................ -- <br /> --_-_----._.-..-_. This Permit Expires 1 Year From Date Issued { <br /> Application is hereby made to the San Joaquin Local Health District for a permit tro construct and install the work herein described. <br /> This application is made in compliance with County.Ofclinpnce No.'549 dhd ezi"sting Rules and Regulations: <br /> JOB,ADDRESS/LOCATION-= = <br /> -- - ---.'.,.- C7-;7Y� �' v - l?��� --.-.CENSUS TRACT --1-=------ - <br /> Owner's Name -' ' ------------------------_ Phone. } <br /> �� .,.. _. <br /> - ------------------------------- <br /> Address c�. s"�C7 �. Y/3 pd"Gc7 City �yAG y Zip <br /> ---- ---- ------------- --,----- ------ ------ ----- �` ------ <br /> Contrattor's Name ,.._` ........ .._-- -¢ � -_-- _ _ ------License # �66'� G_..Phone- <br /> r Installation will serve: Residence;V Apartment House.F] Commercial ❑ Trailer Court ❑ r ' <br /> Motel-❑ Other--'-==---=--------- <br /> s _ # <br /> : ------------ <br /> Num er of ivm units:-.-.1_ ______Number obedaoms_ 3 .Garbage Grinder Lot Size- 3 ------C---Y---�-- <br /> --- --------------- } - <br /> -�I <br /> --- <br /> Water Supply: Public SYstemand name----- j------------- -----------------:----- -------- ------ ------------------ -- Private---- ,-7 <br /> Character of soil to a depth of 3 feet: Sand:❑ Silt ECI Clay ❑ " Peat❑ Sandy Loam JK Clay Loam ❑ E <br /> Hardpan ❑ Adobe❑ F.11 Material-------------If yes, type------------------------.------- ' <br /> i,_ (Plot plan, showing size of.lot, location of system in relation towells, buildings, etc- must be placed on reverse side.) <br /> NEW INSTALLATION: (No'septic tank .or seepage spit permitted if public sewer is available within 200 feet,) ri <br /> PACKAGE TREATMENT [ ] SEPTIC TANKSize----_-_- Liquid Depth------______.._... <br /> f F Di sante to riearest:-W llp.-=--j---'--- --------- --- - �'. 1 No: Compartments--= �----------------------------- <br /> Distance <br /> -----------�------ ------ <br /> Ca acit , Type-- _.: .- Materia <br /> S --- --•---- .Foundation.----3 Prop. Line Sa '..... <br /> LEACHING LINE;- [-]--_No•_'of Lines__________________;_ _--"-""."..Length of each line._._.-- "-.--""-__-_..__--_-...Total Length _Is.�x_s�!{--_---- <br />�� Ter e� ( f/ i �o L� �p `� t -: <br /> � -D' $ox . .......Type Filter Material ._ ..Depth Filter Material..._ -_ _. <br /> } �- �a r / I l r= <br /> Di stance to nearest: Wel!__- ! ......:........Foundation__ __- Property,Line.-..---- ---_ <br /> tWater Table De th__...._________________y[_.__..... Rock Size_.._' Rock Filled Yes ❑ No ❑'C <br /> SEEPAGE PIT. �. [ ] y Depth____ . .___ -.-Diameter----_--.:..'._.'._._Number--------- -------. <br /> � Distance to nearest. Well............. --"- ------- --F - n --,- --�� <br />[ p <br /> a e -- - ou dation - ' .Prop, Line- ----------- -`--------- <br />' SPAR�a DDION ( vSa lion Permit ,� ==Y:Date_. --- <br /> - � <br /> epc (Specify YRequeme1 - -- -------------------------- ----------------------------------------- <br /> 11-5 <br /> ---------------------- -- <br /> s%fir- T- <br /> Disposal Field (Specify Requirements)..-.... ---------- ± ------- - _.......... ......... <br /> -/�/�P ` v -v SP e c. <br /> r ___ ------------------------------------------ <br /> ----- . . -- -- = - = = _: <br /> ----- <br /> I (Draw,eXisting and required addition_on reverse side] . <br /> I hereby certify that I have prepared this appiication and that the work will'be- done in ac ordance 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: r i E•e 1 <br /> "I certify that in the perfmance of the work for which this permit is issued, l i shall not employ-any person in such manner as <br /> to become subject to .Workman's -Compensation laws of California.". .Y . t <br /> •E% i9 T/�e A' Sa ry <br /> Signed Owner <br /> 1 - . <br /> 1 <br /> B -'------= 'Title --------=----'�:_ �1 i <br /> Y ------------------------------ <br /> an towne <br /> x � - <br /> t ( FOR'DEPARTM T USE ONLY �.•. '�: ... , .. <br /> APPLICATION ACCEPTED BY--- <br /> ^'______ ________DA.T.E'�- _ .- � <br /> DIVISION OF LAND NUMBER------------- :DATE.-------------- --- i----- , <br /> ADDITIONAL COMMENTS----------------- I--------------------=------------------------------------------------------- <br /> [. <br /> f . ^ <br /> = -----------------------=--------------------------=-------------- ------------ --------------- -------------------------------------------------- ---- <br /> f <br /> -------------------------------------___ ___j_...__....... -. ..--_-_-_-_.-1­7--- <br /> _1 __ _..____-__-__.____""._"."__-.-_--_--.-__---.-.-.-.--_-----___ <br /> Final Ins ----------- <br />' ection b : <br /> P Y•-'"' - -t'�------- -- - --- - - - ���--------`_- --_------------------------ <br /> D ----------- <br /> - -- ate-' --- ------- <br /> .._ EH 13 24 / ----F S 21677 REV.'7/76 3M"SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r #`--'. IL - <br />