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� f <br /> I <br /> 'w ...... <br /> ! . � FOR OFFICE USE, <br /> APPLICATION FOR SANITATION FI RMIT -7 7 <br /> I , (Complete In Triplicate) rc.AP"► odd Permit No. <br /> ........................3.. .. ...._........_..... pat,ti Itwed <br /> t' r ..... <br /> This Perrnit W[ Ir+sr 4 Year%*I"Doh fssvw , <br /> Application Is hereby made to the San Joaquin local Health District for a permit to canttnid ord intM1E the werk fsetrtw <br /> i. described.This application Is made in comphonce with County Ordinance No. 310 and existing Rules and Regu{atlower,7`•, <br /> v 2 0. ., c>rr..c�. oS... -c............... ......................CENRIS TRACY <br /> .............,:...:...... <br /> JOB ADDRESS/LOC.ATION .....5.. <br /> Owner's Name . . .F... .0-: .Fp. ................................................... ,.....................................P}tioese.ri!E..S!3 ,Z.Zr - <br /> Address S.C,.Z.O ....Mr�r c�,�p�s'�:.... ............ .. .....................City ....5-,�"ti?G .7.Af"7...... .................................i». <br /> l..r . Contractor's Name....l�c.!-r,..F.l).....f._..5 c.y 5.......................................License i .�'�,��l ..Y. .... Phone ..�1 F ..9 o.� <br /> i <br /> r• Installation will serves Residence�partrnent House C]Commercial QTraller Cow #] <br /> Mote(❑Other............................................ <br /> Number of living unitst....�..... Number of bedrooms —I.......GarbaQre Grinder ............ lot Slee .... l ,f...............••••. <br /> ' r .. _..................................................Prhraf*B! <br /> Water Supply: Public System and name . <br /> Character of soil to a depth of 3 foots Sand❑ Slit Q. .Cloy-Peat❑ Sandy Loom❑ Clay I O R Q <br /> Hardpan Q Adobe Fill Material............If yet,type.......................... <br /> ``- lPlot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on r,vwne elder <br /> h <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer b available within 400 feel,) <br /> LSqukf Depot ' 'D'' � ' <br /> ;1; r PACKAGE TREATMENT [ ]: SEPTLC TANK( I Sine................................................ ................ <br /> Capacity.................... Type .................... Mawlal...................... No. ComporfnwnM ............:.:....: <br /> ` Distance to neoresti Wel) ..............Foundation......................Prop.Lira............... ... <br /> Length .......................»_ <br /> LEACHING-LINE O No. of Lines ........................ Length of each line............................ Tafel [ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ......................................... <br /> Distance to neanitr Well ........................ Foundation .... ................... Property Eine ................ If <br /> ... <br /> Diameter ................ Number .......I.................... Rock Filled Yes C) No Q <br /> SEEPAGE PIT Depth .................... <br /> O <br /> - Water Table Depth .................. . ..........................Rock Size ................................ <br /> Distance to neareste Well ........................................Foundation .................... Prop. Lira .............».... }� : <br /> REPAIR/ADDITION(Prw.Sanitation Permit#............................................ Date .................................. <br /> ) <br /> ..................... <br /> ................. ............... <br /> 'i Septic Tank (Specify Requirements) ......................................... ..............................y».. ' <br /> .' o�.r.�...e� s.,3...X.. ��.!. ................................. <br /> Disposal Field (Specify Requirements) ......Y v. 11x. t•r! <br /> aA ............................................................................................. .. <br /> ; .:......... ............................................ ....... .... ...........................................................-................................ <br /> s """ (Draw existing.and required addition on row,as side) <br /> X:, <br /> ( hereby certify that 1 have prepared this application and that tlhe work wiN tee done M aicterdeuree Mrith taw <br /> County Ordinances, State Laws, and Rules and ileguWons of the San Joaquin Local HedH+ District.H~WOW er.Ileew• <br /> (.. sed agents signature certifies the following: <br /> hall not ernplet►Ory persea In sacs nramtes <br /> ' <br /> 0'1 certify that in elle performante of the work fer which this p*"Mt is Issued, I s <br /> become subject So Workman's. Compensation laws of California.' <br /> kr� •< <br /> t Signed ........................Owner <br /> . � <br /> . Title .....!f a !! fv ....... ................... <br /> Y!i 13 ............. <br /> '! y other than owned <br /> FOR DEPARTMENT USE ONLY •,r,^„ — <br /> APPLICATION ACCEPTED BY ..... f.�:�:! f ............. DATE �^'. 'Y..-_.......... . <br /> BUILDING PERMIT ISSUED ............ ...... ....••••....•.................. .. <br /> DATE . <br /> ADDITIONAL COMMENTS .— ... ...................._............ .. .., ....... ... <br /> ...t...........:.......................... <br /> . .-........ <br /> d .. ......... .... ..............yl/........_. ........_. ..................... ........ ................. ...... .._...... _.. ...... .,,. f.,r.... �................... <br /> :.. <br /> -- : .:• . ....Date .., .. <br /> Final Inspection by . / ..:.:.....:.'................................................... . ................... <br /> EH 13 2h 1-611 . Rcv. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h <br /> d # <br />