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' FOR OFFICE USE: FOR OFFICELISEa Y < <br /> APPLICATION FOR SANITATION PERMIT <br /> . Perm t No <br /> ' (Complete In-Triplicate) <br /> Date Issued.-Z3-1.1. d <br /> This Permit Expires i Year From Date issued <br /> Applicution is hereby made to the San Joaquin Local Health District for a permit to construct and install the <br /> work herein described. , <br /> / this upplicarion is made in compliance with County Ordinance No.549 and existing Rules and Regulations: <br /> rr <br /> t JO2. ADDRESS/LOC.ATION...A.4i••S.A. . .trde4rW.7ril?. § <br /> X....-4.*1W.i6..- .46.A eb..............................CENSUS TRACT Z.....'t <br /> Owner's Name <br /> ...K1.,G�C...1.►..6tIrIR .... s + / o , <br /> 'Z <br /> 197 <br /> IPhne., <br /> S41 City. t .... p 7 •; <br /> N. Contractor's Nan:e...Z? A. ...P.A.R.e�.S.iI•.. ,,5!-w x....,... , ,, ..:,..':......,License ..?5 3.! '..f . . .PFione.-.9r*4t(r...91�0./Z <br /> r Ir,stailation will serve: Residence® Apartment House p Commercial Q. Trailer Court [] I� <br /> t Motel [3Other.::•......... ... <br /> r f4 <br /> N::mber of living units•... .....f <br /> .. .....Number of bedrooms.,. Garbage Grinder......:.....tot Siise....1.3�9�X •��' <br /> Walor Supply:pP Y Public System and name.. <br /> .......... <br /> .. <br /> Private <br /> ;t Character of soil to a depth of 3 feet: Sand Slit Cla " <br /> ❑ ❑ y❑ Peat❑ Sandy Loam 0 ' Clay Laamti ' <br /> � <br /> Hardpan ❑ Adobe it Fill Material ...If yes,type.......................:...... k x <br /> -(Plot plan, showing size of lot, location of system in relation to wells, buildings,etc.must be placed on reverse side. <br /> ` <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 f PACKAGE TREATMENT ' SEPTIC-TANK ...,., . .`.4. <br /> . feat,) <br /> ................... .. Liquid'Depth'..`.`:t <br /> j <br /> Capacity..A.2OCJ.•¢,ts.Type........ Material..41< �!r¢+ wxr+7....No. CompaMmenti`. ..wZr.: ` <br /> gJ Dlatalica to nearest: Well.::.s!iPA f�. ... .... ... Foundotion.... iProp:line`.:;.Tf' <br /> t : LEACHING LINE [ }' No.'of Lines .-,.A... . Length of each line pQ.. .Total Length. . :/.8ft.., <br /> D' Box.. .Type Filter Material....Z4V-GJ�...Depth-filter Material....: <br /> „Distance to nearest, Well..-l0®t' '...... Foundation.....�Q? .....:..... .Property Line 0.10s <br /> SEEPAGE PIT. <br /> . <br /> Depth -. .............. Rock Filled Yes p N <br /> I 1 -....,...•.•.....Diameter...... .Number <br /> Water Table Depth.............. ......- ...:.........Rock Size. ...... .. t> <br /> r, <br /> h ' <br /> Distance-to nearest:.Well :............Foundation - - Prop tLme :. <br /> i <br /> REPAIR/ADDITION (Prev. Sanitation Permit,�l6._-:..:........... <br /> .. } <br /> .............M te_...... <br /> Septic Tank. (Specify Requirements) <br /> ....... .................. ............... ... ...•. 4 xi. <br /> } Disposal Field (Specify Requirements[- <br /> . ... qtr <br /> . ...... ..... <br /> ............................ <br /> .................................:................... <br /> .,� ...................................:........................................ <br /> _ ........ ... ..: <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will'be done in accordance with San.Joaqufn County <br /> =� -Ordinances, State'Laws, and Rules and Regulations of the San Joaquin Local Health Distdct, Home ovrreor OUR consid 4Q90"t$ <br /> signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit Is issued, I shall not employ any penon.in ouch manna vsz t <br /> to become subject t Workman's Comp' nsotion laws of Callfornla." <br /> ' 4 <br /> Signed. <br /> �j <br /> .......:..... .....:'..:....:..Owner <br /> N 5 <br /> 8y..... . ._-. ......:.......... Title....... <br /> :.: <br /> v <br /> other than owner} <br /> FOV DEPART IE T USE ONLY <br /> APPLICATION ACCEPTED BY......., . . .. . .. DATE.:.:. . ..['� ..'� .......... <br /> ............ <br /> DNi510N OF LAND NUMBER .. DATE:....... .... ; <br /> ......... <br /> ADDITIONAL COMMENTS, ........... ..... ....... <br /> 4 „ <br /> 3 ..- .. ... .. ... ..... ... 1 ..... - -... ....................... <br /> by: •.rr�C.l ................ ................. •....:......;..., ..... <br /> .. ' �. ..-� - �,;• <br /> .Date.. .?.�,Sl 7:. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT lie»osv 7/76 tM. <br /> r 1 s � <br /> f <br /> 4` �Ry <br />