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_ rr i�tr <br /> M. <br /> FOR OFFICE USE: FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> ................................. ........ ............ <br /> - (Complete in Triplieatel Permit No. -• , ��>>,, <br /> Date <br /> .........:............................................ This Permit Expires 1 Year From Onto Issued <br /> Application <br /> is hereby mode to.the San Joaquin Local Health District for a permit to construct and install the work herein descri <br /> This.application is made in compliance with Cou�ntty.Ordinance No.,55449aand existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION .//.s�GT..` /T..I���A� 7sy JS TPA <br /> C7.... <br /> •GENS CT: <br /> CMnar s Name .a.L Q ^//�j.��E /w_G. .............. .... ........ Phone_'�� ._� �'T�1• <br /> Address_-- .. { .<. .:..J-...-..::-..,:/...... ................................. .. .....Cify.(�(J7.'L1 -�.�.1�........- .- ZIPp -' S. . <br /> Cantrou:yor's Name :.... /s�. llL,G.r.�". .....License/vS ..;Z.Phore...p 6� Y !' <br /> Instailntion will serve: Residence Apartment House Commerciale' TraileGCourt C3 > <br /> • ;r `t <br /> `I Motel ❑ cO/ther.............. .......... •� _ :r <br /> Number of Its"no unix . .. . Number of bedrooms. 3 . Garbage Grinder - Lot Size C-J <br /> "�- <br /> .Water Supply: Public System and name................ ....... .... .... .....I.......... ..... .. ....... ._....... ._. �....�.^` Pri h _ •f, <br /> Chcroct :of soi! to a depth of 3 fees Sand❑ Silt❑ Clay❑ Peat❑ Sandy loam Clay loam 17, <br /> Hardpan❑ Adobe❑ Fi!IMaterial.. .... ....if yes,type...:...................... <br /> (P'ot piae, showing size of lot [motion of system In relation to wells, buildings, etc,must be placed on reverse side) <br /> MEIN INSTALLATION: (No septic tank or,seepage pit permitted if public sewer is available within 200-feet,] �. <br /> uACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size...... .... ............. Liquid Depth... " s <br /> Capacity. ... Typr a Matorai -: ... No. Compartments:.: 1. . tr% t�'W <br /> Cistance to nearest Well..:.:....�...... ....Foundatir n.... .... .. . Prop. <br /> ..... .. <br /> LEACHIF!G tiNE ( 1 No. of Liner .:Aengthpf each Gina-.._., ...... Total Length =. L f"iY�t�`• '•T�'�a <br /> ._ <br /> .- . ... . _ Filter Material ......... .:[• ':1 <br /> D' Box Type Filter Materia .._<. ..... - •- c��_• <br /> - _ ...Depth <br /> : Distance to nearest:Well. ..: :. Founclatioi ` .......Property line..:: -w" <br /> SEEPAGE PIT ( ] Depth .....__..Diameter. ..Number: ........ ...... Rock Filled Yes❑., ' 6Q- <br /> +v M <br /> . Water Table Depin ........ .... .. - .......:..Rock Size . .... .:1. <br /> ' Distance to nearest:Well Foundation. Prop Line t, 't <br /> .�Y aYy <br /> REPAIR/ADDITIOt (>rev.'Sonitation Permit#... ..........' , ::,.Date ..._...1 _. . ...:.le <br /> ) <br /> ' Septic Tank (Sprify Renuireraentsl " - rf-- ---- ---- -- .,,K•�c ' <br /> Dispeso' Felc 'Sr^-c,fy Requirements!. ... ... � /fV.-:f�..GGC� `�-' � . .. . ..... • 1+ `�Q+•:. <br /> ..: <br /> ` l k. <br /> gq <br /> (Draw existing and required addition on -verse side) <br /> `,f heti(r�==by canrry thct I have prepand this opplicatioand that tho work will be dens In accordance with San Joaquin Coot , <br /> `Ordinances •,ut;:,lalvs 'and Ruins and.Regulations of'tho San Joaquin Local Health District,Home owner o licensed <br /> ,. stQaatvro Cert fuse t wto <br /> e { <br /> +� o Cszrtifv 'her rn tfi riti F.the work fol which this .ermi � swd, 1_shall not amPiey any Person In such}m naer{tljr <br /> P P <br /> to t-e<omae�a<t 1 ork i`Cornp'compensation lawsof California." ' <br /> a i <br /> :..... <br /> .8y...:... .__..:...: . :..... ... i -... ..::: _..._.. - .Title.:.:::. . . ...... ....:_......- ..._-....-_ <br /> (If other than ovner)' to i <br /> - FOR DEPARTMENT USE ONLY <br /> •` APPLICATION ACCEPTED BY. - -- - - - - --- ........ <br /> DATE S <br /> D0ASION OF LAND NUMBER... � .. .... .....: .. ... . ...... . ..---------DATE........ . <br /> 'ADDITIONAL COMMENTS_ .... ............. ... ...... ..- . ... . '•. <br /> .-. . - . y: <br /> J ....-. .-. .. - _ _ -. - .........---Date <br /> ....-.._ pI .. <br /> r:^I Inspuoton by, . ... .. ... .. ... ........ a e_._. :.17.. ... . . _ <br /> A <br /> 79. <br /> N u 24 AN JOAQUIN LOCAL HEALTH DISTRICT ru mer. uv vie sw <br /> - ..fir-.��•�•ew..r.www.u..�a+e:,Ya.ri',..fc..±'¢'Lb,•„„ -� -s <br /> - 'O�e.• >_.. -. wY • .., aol•A`)u.SwsiC;.•:t• ,.y,*'.'�•a ,�j�.'.�r?;S�.r' ^�"'"�y#+'F,y�Y� '��i ..��! <br /> n ,uZ <br />