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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7 <br /> ............................----- ------------- - (Complete in Triplicate) Permit No----"--��- t <br /> ------------------------------------------------- � ate I ssu ed..Z� <br /> � D _... <br /> ........- ----------------_____--------------_....._ This Perrrrif-Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County,'Ordinanc No.549 and existing Rules and Regulations: _ <br /> JOB ADDRESS/LOCATION...._L..L..IL"sr ...-:.... - .'--'---,..---------.... _ ..........CENSUS TRACT.-------------- <br /> Or //..�� ""��"" `� .fl___.. ......X .... r <br /> wner's Name......... crrrysT�-- - '- ---------------- - ---_--- ----Phone--- ...-------- <br /> r <br /> Address. ------' `Fi' l7- ..._. -- .- sty. .. -- - ------------Zip-------------------------- <br /> ' .....----------- <br /> Contractor's <br /> z. ` r <br /> - C <br /> Contractor's Name...(-'- --.._ ...:.. ..� - - ---- �..---+, "..--'----Littnse Phone-r------------------------------ <br /> Installation will serve: Residence Apartment House �Cfmr rp101 �Trailer Court ❑ y <br /> Motel ❑ Other.. C6.aaFR•-.arr.l[:. �.r!/rio.G;� �— '�"`d" , <br /> Number of living units:. y-. Number of bedrooms Garbage Grinder_.}- Lot Size _ ------------ <br /> Water Supply: Public System und•name.. -- - -- - -- - .....:. - - .i-,-- --^-----------------------. --. Private ❑ <br /> i `•t1 - � — ' <br /> Character of soil to a depth of 3 feet: '� Sond ❑ Silt❑ 'Clay E� Peat[]:� }Sandy eam 11 Clay Loam Lr/ i <br /> A Y Harden ❑ ` Adobe❑ Fill Material._..:. If yes pe......r.:..i i <br /> a .............. ...... <br /> (Plot plan, showing^site of lot,'location of'system in relation to wells, buildings, etc.must be placed on reverse side.) <br /> NEW INSTALLATION:• (Noi.septic t ne pa <br /> k or seepagrilted if public sewer is avpilable within 200 feet, <br /> v mrv.�e f <br /> PACKAGE TREATMENT I j--FS-EPTJC'TANK I ) r„� SSze......_............. ....... .... .Liquid Depth:................ ..... _� <br /> . --.--�--- <br /> M!pf <br /> .�, - - -- ._MaaNo. Comp(> : -e � <br /> r <br /> ,,;. . <br /> Distance Well - .__ FSlyJndatiowi .... -Prop. Line.. . . <br /> 1 i y — — -s�'.._...._c--- <br /> LEACHIN6,LINEiy). .-No: o�s� ._.Length of each line --, . r � TotallLength-- ---------------- 1.. <br /> 'D'.Box.....i...---T a filter-Materials-L--:-- II�pttTFilii '1iAa ria_I------ .... ----- <br /> ' I Distance to nearest-"Well+.--. ..i. 1 Foundation. .' .......... .Prop <br /> eIr'ty..% <br /> Line..... . --- <br /> A <br /> SEEPAGE PIT I ) Depih ...;. biometer'; :Number ....._ ...:...._' �+ Rock Filled •Yes❑ No❑ <br /> { Water Ta �e Depth ..:... " ' f--- ---------------...,_..Rock Size;------- <br /> b <br /> ! <br /> Distanceto!nearest: WelL.......... ..:.----...-...•-.-.'.-.---Foundation........----._Y___�Pro <br /> - p- Line-----'.-'-.........._.... <br /> REPAIR/ADDITION (Prey. Sanitation Permit#_,......---_.............. ..._-_-......._...Date:._._____..-.e.- � � <br /> Septic Tank (Specify Requirements)---I-- --------- .......................----------- <br /> ---- <br /> ..i__. <br /> ( Disposal Field (Specify R` /�ireme is am - <br /> ,. <br /> t _ - (Draw axishng <br /> and reqq uired addition on revers side} <br /> 1 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: San Joaquin Local Health District! Home owner or licensed agents <br /> signature certifies the following: ; <br /> r "1 certify that in the performance of'the work for which this permit is issued, I shall not employ any person id such mariner as <br /> I to become subject to .Workman's Compensationlaws of.California." <br /> Signed-T..................................---------)-- -' ---------- _. .. .. _Owner <br /> By...... <br /> I ...I-------------- -' - <br /> (If other than owner) <br /> D -? <br /> R DEPAYMENT USE ONLY. <br /> jAPPLICATION ACCEPTED. BY--- '...- - ' - .......-.....`.. ------- DATiAlt�!?- --- ---- ---- - <br /> DIVISION OF LAND NUMBER.. ........... --- -------`-- -- DATE.'-.................. ------ <br /> ADDITIONAL COMMENTS. .............................................- --- ------------------------- ......................... -...... <br /> r_ <br /> ., - - .r . - <br /> �- ..._1.----......-----......_.................----------...:--'-'--_n_-;'----_...._"---'_---------_..................--------.._.._-.---:.....--`-"--._----._--------- -- --- __ <br /> --!........................................._-- ........­­ ------------- --------------- -- <br /> . ............----.._._-........_�' i-- - - - ..............- <br /> t l Inspection by:. =i V. ............................._ - _ .. Date.��5::�.. :... --- .. <br /> 1`.. <br /> Fina = <br /> ...... -' -- - ' <br /> to to 44 SAN JOAQUIN LOCAL HEALTH DISTRICT Fss men REV.7/z6 are <br /> l�.. <br />