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FOR OFFICE USE: <br /> r .{ APPLICATION FOR SANITATION' RMI <br /> ;PET,`' FOR OFFICE L::. . <br /> ------------------------------------------------ <br /> itPermit No.. <br /> I {Complete in Triplicate} --� - <br /> - � `- <br /> �.. = _: t. Date Issued" 47�2 � -_. <br /> ------------------------------------------------------I _ isyPermit Expires 1I.Year From Date,Issued _ <br /> Application is hereby made to the San Joaqui Local Heolth�,District for a permit to constr c�install the work-herein described <br /> This application is made in compliance with my Ordlnonce:No. 549 and existing=Rules"and,Regulations:' <br /> JOB ADDRESS/LOCATIO - S% CENSUSTRACT. - � <br /> Owner's Name.... IN3� , <br /> " = <br /> Address __ ----------- CGw <br /> r <br /> �. _ i <br /> Contractor's Name I License #'' - Phone_- - ------ <br /> Installation will 's ve iRe idents <, Apartment�House o ercial ❑ Trailer Court ❑ <br /> i ---- <br /> 7. <br /> z <br /> - Motel ��. Other �• �;�, <br /> F Ag <br /> Number livrn .units � ;___ __Number of bedrooms Garbage Grinder___;. -Lot Size__' <br /> a9&4v - <br /> - e namr Ir ' <br /> Water SupplyPublic System and -- , ---__ ______"________ ___ PrivateZIA <br /> r�Char cter�s#jsoi-to-qth of�3?fee#:. Sand:: Si.l.t Sad Loam <br /> ' Peau:®�„ ,Y ��Clay Loam ❑�_- „�•.�:; <br /> and an Adobe Fill Material----- ------If yes, type ---i---- ------ <br /> L_ jA <br /> bowing size o ot, ovation ofisystem in relation to wells, buildings, etc. must be placed on reverse side.) <br /> LLATION: �[No?seti tank 'or`seepage pit p rifted if. u. lac sewer is available within 200 feet,)Ca acit _ _��, � -- Size--��a ���L_�. Com.aiquid Depth : -+��:_REATMENT SEPTIC NK T e ��- Liquid <br /> f" p r rr nts'Z` <br /> p Y I Y--P s a .1 . f t 6- f % <br /> t Distance o nearest Well Fauradptio •__. 1.,,;Prop. Line "t <br /> LEACHING LINE [dj' No. of Lines._-__ __- .Length_o each.iina. _ 2Total Length. "} <br /> D' Box -y---T - Filte Material / �• /�_-Depth Filter Material-------------------------------------------------- <br /> Soo <br /> Distance to nearest: 11_: "__ _ ________-Foundati"on___- "_ _"__-__ --_Property Line_-__•____ <br /> SEE�Tv ti"Q f [i... / " •X! a . .7 i ,., . <br /> ( �}' Depth.` _ __ D>txrrtef�r.:_____-_4� Number :__ _ Rock Filled«Yeses/ No <br /> V y - <br /> [ Water Table.Depth. _!1.2 -------------- -- "_.�-'Rock ize g F ^ - -------------------------- <br /> # Distance to nearefst:Well :.�©O-F- .- I_____________"_-1___.Foundation- '��-- ___--_.Prop. Line-___-5.00 <br /> REPAIR/ADDITION .[Prey.Sanitation-Permit*___.-- _:_. -____-____-_?_____________ __F-__.Date_��_ __-------'�' <br /> f ._.�.� it � a <br /> ` I --------- --------:_--------------- - -------- <br /> Septic Tank [$peclfy�Requlrementsli---L-- -�—�---------------------------- _ '-"� ---------------------------------•----- � <br /> p 4"p V q j <br /> ents) ----'-----------------------------' <br /> Dis- osd Field ----R �I 41---:--- ---_ :----=------ --------- ------------------- <br /> Xi , <br /> _-- --- ----- - _ <br /> } - <-F r F-----:- - - ----------------------- <br /> --------------------- wr� <br /> � 1 <br /> .[Draw existing and required ditiorr°`on_reverse sid <br /> I hereby certify that I have pre ' red this lal�iplicatlon and that the wo _in�acco to withpSon Joaquin Count Z , <br /> Ordinances, State Laws, and Rules and Regulations -of the San Joaquin Local Health District. Flame caner or licensed agents <br /> . _�� t=,�=-.�,.--�•'^"--r---_.:..�..r-•�-:.-#.-,�-b.�n•.�,�.,.-,---^.,.,:.4,.��-ice 1,._..,.� • .. � ---�--�•� <br /> signature certifies the following:`r, ; <br /> "I certify that in the'performance of the work for which this permit is issued, i shall'not employ,fany p6son in such manner as� <br /> to becomWsubie to Wor ans Compensation laws of California."Signed--- '-- ------------=------------- --------------Owner ..,, <br /> BY ; ----------- --------- --- e r � 1 <br /> ,----= <br /> t <br /> Title--ti.�!!u <br /> E {!f other'kthan owner) <br /> } <br /> FOR DEPARTMENT USE ONLY' <br /> APPLICATION ACCEPTED BY'----''� L' fS = :::__. `------------------------DATE--7+Y"-`�=-- --=------------ f <br /> DIVISION OF LAND NUMBER--- ----------------------------------- ----------------------------- ---DATE----- " 3 <br /> ADDITIONAL COMMENTS --�----------------------'---- <br /> -------------------------------- ----------------------------- ----------- <br /> -------------"----------------------------------- I(-----------------------------_--=--------------------=----------- --------------------------------------------------------------------- ---------- <br /> r . ----- ---- ---- -- <br /> . 14 !", - ------------------- <br /> ------------------- -----•-- -- ------- `� <br /> ----------- - --- -------------------------------- ---------------------------- -- -- <br /> Final Inspection'bY:----------•C-':. ------ - = ---_--- ---------:--------=---="-------------------- --------=-----------Date---3- --- ------------------------------ <br /> EH 13 as SAN JOAQUIN LOCA L`HEALTH DISTRICT( FRS 71677 REV. 7/76 3M <br /> Y <br />