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Foe OFFKE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT P7 7- 1,711 <br /> Permit No <br /> (CempleN In Triplicate) �» Isi�red � A7 <br /> J <br /> This Permit ExPlres I Year Frons Do*Issued <br /> - --- mit to construct orad install tine wesb heyert dsva,'bN• <br /> Application is hereby made to the San Joaquin local Health District for a per <br /> with County Ordinance No. SAO and existing Rules and Regub»ans- <br /> This application is mode In compliance <br /> AAle, CEWSUS T RAcT <br /> JOB ADDRESS/LOCATION /' Flso�w <br /> Owner's Nome .` -�'�'c/I� � City ��,. zip <br /> j <br /> IG�' licenseAddress <br /> • <br /> Contractor's Nome <br /> mom <br /> Residence Apartment House C1Commefciol❑ Troils Caws ❑ <br /> Installation wl{I serve; Motel(_] Other <br /> Lot SiSizeNumbof living units, Number of bedroo �m• Garbage Grinder <br /> er <br /> Water Supply: Public Sy*tem and name <br /> Cherarier of soil to a depth of 3 feet: Sand C1 Silt 0 Cloy❑ hat C] Sandy Loom CbY leOrM <br /> Hardpan 0 Adobe C] Fill Motefiol If yes,type .....��=a..... <br /> (Plot plan, showing size of lot, locatia, of system in relalion taw ells,buildings,eft.must bo placed on reverse side) <br /> NRW INSTALLATIONi (No septic tank or senpoge pit permitted if publi;sewer is ovOiMblo w"ho"200 4ot,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK ( ) Si" <br /> L:gwd Depth <br /> . <br /> IMetsiol .No. I',�sportrn.nts <br /> Capacity Type <br /> Prop, line . <br /> Distance to nearesh Well .. ~ ..'. <br /> LenpM Of each lit <br /> No. of lines s► ...... <br /> .........,Total letgM . _.... ,_...... O <br /> LEACHING LINE l 1 ....._-..� <br /> 1 Depth Filter Moteriol ..• » <br /> 'D' Box Type Filter Material .........»... .. <br /> Distance to nearest.Well Fojindation ........... ..'.. "., <br /> proper" Line "Z <br /> Diameter Rods Filled Yet G NO❑ • <br /> SEEPAGE PIT ( � Depth Number . . . .... ... ........ ... <br /> Water Table Depth ......................... .... .». ... ....... ..Rock Sittit........... .. . _. <br /> .. ..... Prop. Line..... . ._-- <br /> Distance to noarest, Well <br /> REPAIR/ADDITION (Prev. Sanitation Permit tP «, ,........ <br /> Septic Tank (Specify Requirementsl /��1 <br /> DisposalField (S <br /> pecify Requirements) ...al.e-4.cz '- F�/" » ....�"" »... .. ..�..- <br /> X .��..,Ic.�,.s �a'ItPRt. t ... ... .... ...........»._ ...».;..:........:.... ..... ::: ............ <br /> .... <br /> .......... .................... <br /> ... <br /> ------ <br /> (Draw existing mW required addition on reverse si • <br /> 1 hereby certify that 1 have prepared this application and Met Mo wsk win be done In occerdenco with few �Ms't^ ��y <br /> Ordinances, State Laws, and Rules and Regulations o/ the Sen Jeepuin Leval HealthDistrict- Nocsso ewtner N Ness <br /> esod Mit <br /> st*wature certifies the fellewing: Is ormanneir ee <br /> �y certMy that to the performance of " work fa wMch this Perndt is Issued. I shell not ewnPlsy airy Per"" is <br /> to become subject to Workman s Compensation laws of Coliforms. <br /> 1 � own <br /> s <br /> Ngn.d Title <br /> ` <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLYDAT , <br /> -- --� DATE .. <br /> APPLICATION ACCEPTED BY - E - <br /> DIVISION OF LAND NUMBER <br /> ADDITIONAL COMMENTS <br /> .................................................. <br /> F ................. . . : :.:: . :..:.::::...... ......::.:. . .....::...oma:...... ..... v.v. .» <br /> Final Inspection byr rst rsn nv.siss sr <br /> a 13!. SAN JOAQUIN LOCAL HEgTH DISTRICT <br /> 5.•r�r�'7R11 R1�7f3M't'"�6o ,i.. ,,..w—�,{�.. :1'Sbt:,s+--r.. - <br /> •�ii -. <br />