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4 <br /> FOR OFFICE USE, FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7_9� <br /> .......... ...... ---------------------­-----­------ Permit No.__ ­-1,e_>�?_ <br /> (Complete In Triplicate) - ------­_ <br /> Dote Issu <br /> ------- ---- ----------- ----------............... <br /> ...... ---------------- .... This Permit Expires I Yoor From Date Issued <br /> X" ffi <br /> Application is hereby made to the San Joaquin-Local, Health.l?istri . or a rmit t;c�onstrancelll�n_stall the work herein described. <br /> This application is made in compliance with'County Ordinance No.,549 and existing Rules and Regulations:JOB ADDRESS/LOCATION../`­�`�-f./"Z" ..w........Zt:W.ZCENSUS TRACT__... ----- - ----- <br /> --- ---------- -- ----- - ---- ......­----------------- ------------ <br /> Owner's Nome. . .. ..... A�&oA� <br /> Phone e� <br /> ...... ..........._CIty_._.. .... --Zip-- ---.. ... ..... -------- ------------ ---------_ <br /> Address.--............. ...... . <br /> Contractor's'Name------ 1fK P.. ------ ...........I----------.......... ------- License ---------1.......-----Phone....- ......... <br /> Installation will serve; Residence A Apartment House 0 Commercial E] Trailer Court El <br /> .-Motel,-E] Other,.............. ---------_---- <br /> Number of living units:.J..........Number of bedrooms..,3-.-Garbage.Grindet-40--:Lot size....x <br /> Water Supply:'Fublic System and name----------........... ----------­­-------*------- -----------------.............. ----------------_._.Private <br /> Character of`soil to a depth of 3 feet: Sand [I Silt❑ Clay E] ' Pleat❑ Sandy LoomY Clay Loom [I <br /> ,HardponE Adobe-C] Fill Moteriol_....--if'Ye-S,type............... ...... <br /> (Plot plan, showing size of ioi ­Joccnion of systerrL.In relation to wells, buildings,etc. must be placed on reverse side-) <br /> NEW INSTALLATION: JNo septic tank or--seepage pit.permitted if public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT I 1 SEPTIC-TANK,[) ..Liquid Depth - ------- ....... <br /> Capacity..,. • ---TypeL----- mqterial...... ................No. Compartments..........- <br /> Distance to nearest. ............................Foundation. .. ....................Prop. Line----- -------------_ <br /> -c - ;a/ <br /> L I8ACIe1NL?G/(& No. of Lines. :__ ­­12�rIgIth of each ..._,_Total Length_ 7. . ........_.•... <br /> � /-----------* :1 #0 IT <br /> Z' Sax../......Type Filter Material NZ-A--------Depth Filter Material. ...... ------------i---------------- -- <br /> Distance to nearest:Well---- V.-d r-.... <br /> /� x.... Foundation___A0'_',0L------..-..Property Line...45-11--------------------- <br /> 4AEP*8E_P4;F Rack-, .,r NC�.[] <br /> - - -- ---------------- ------ ...... ....... ------I­­­ ----­------ <br /> CjOtqape,t"e At <br /> .........-Foundcrribr.- O.Y-------- ---Propl.­6iAe-_S._ <br /> REPAIR/ADDITION (Prev.Sanitation Permit#----------------- ......___-----..Date...... --------- ........ I <br /> Septic Tank (Specify Requirements).--_ kk;�Ielf c*4 <br /> ---jen A <br /> V� - 0- --77...... .................... <br /> Disposal Field (Specify Requirements).��)"C_.Ve - —-------- ------- - <br /> .................. ------ - ------------------------------- ......... <br /> --------------------------------- ................... ------------------- ------ ---------I--------------- ........ <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 Son Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that !I thatinr cc err...._.--_..... <br /> aror which this permit is issued, I shall net employ any person in such manner as <br /> w <br /> to become su ma ompe ation laws of California." <br /> ... . ............... ........Owner <br /> By......--'....... -------- - ------------------- ............. -----------Title._.........._.._ .._......... <br /> Of other than owner) <br /> FOR PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... _ ...... ....... ......... _2L ............... <br /> ..--------.DATE.-./ <br /> DIVISION OF LAND NUMBER - --- ---------------------------­--- .............­­­ ....... -------­­-------- <br /> .. .....r=-fen. ....4-d>e------�Zpg <br /> ADDITIONAL ( > AMENTS.iXw <br /> _-- ------ ........__..............-- ---­-----­--- .................... .........­.......­.......... <br /> .......... ----------- ...... . .........­­­------------------- ----------- ........­­ ------ -­-----------------------............... <br /> - ------------ <br /> ------------- <br /> . <br /> ------------- <br /> ......... <br /> Final"Inspection­by:m­ <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV,7J76 SM <br />