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FOR OFFICE USE. <br /> FOR OFFICE USS.: V/ I <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No..7-f <br /> (Complete in Triplicate) - <br /> II .......... ........... ssued_).­:-01_`5 <br /> ----------------­ Date I <br /> This Permit Expires 1 Year From Date Issued <br /> ............. -------- - <br /> Application is hereby 'Made to'.the San Joaquin Local Health District for a permit to I construct and install the work herein described, <br /> This application is.made.in.complioncewith County Ordinance No. 549,and existing Rules and Regulations: <br /> ------- ------- ----- <br /> J06 ADDRESS/LOCATION.....1-0-/------- .......... --------------------------------CENSUS TRACT_ <br /> � Phone....... . ,... .......... ................. <br /> - ---------- <br /> Owner's Name <br /> ............. <br /> Address---- ---------------------------- ..............�­___­ .......... ...... city <br /> License <br /> #-.127.r -...Phone-- <br /> Contractor's <br /> it <br /> Installation will serve: Residehce W Apartment House ❑ Commercial C] Trailer Court El <br /> . <br /> Other-------- ------- -----------•----------- A <br /> , � � ...� -4 ._.1---;.­­...... ..... . <br /> Number of living units:. .... . ----Numb�r of bedrooms...0.--L-Garbage' Grinder-----—--Lot Size... <br /> ----Private <br /> ................................. <br /> W8ter Supply: Public System and name....._--._..__..- --------• .......... ............ --------------- <br /> it. (11 Peat El Sandy Loamf] Cl�c�y_Locim Ej <br /> Char-acter-of-soil,to-a-.depth-of-3,feet;— _Sand}: -Silt❑ _Cl��YJD:7 <br /> Hardpan ❑ Adobe E] Fill Material',%-... . ..If yes, type------------------------------- <br /> (Plot plan, showing size of lot, Ideation of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (Nosap <br /> c-tank-or-seepage pitEtrmittecl if public sewer is available within 200 feet,) <br /> i id Depth.-511' 4.. ..... <br /> %'. <br /> .... .... ...........L qu <br /> PACKAGE TREATMENT SEPTIC TANK M Size....f- <br /> 'I— nts.... ---------- ......... <br /> M a t ar i a <br /> 4_�----No, Compartme <br /> Capacity-/0?0.0-----Type/—W-W_� <br /> Distance to nearest; Well--:...... .................. Foundation ---- -------.Prop. <br /> Line <br /> Total Length <br /> No. �f Lines..... -------- L qn , —o. <br /> _j?CJ._-.Type Filfer Mat ri tH Filter Mated, <br /> a <br /> _;D-Box. dria <br /> Property-Line <br /> �T60561-fffi -7 <br /> Distance 10 nearest:a t' Well-.-' n --- ------ e s <br /> flk- Reek Ri.Usd <br /> -------------­---- <br /> �­.._Diai2A.64ef------------------�,N4y <br /> IR ------------- <br /> Wntpr ........................ V_ _/1 <br /> .1 -------Foundation77.n...... ....... ......Prop. Line.... ........ -------- <br /> Distance to nearest: Well_---------__-------- <br /> ..........L._.Date---------------_------- -- ------- <br /> REPAIR/ADDITION (Prev. Sanitation Permit ......................... <br /> - ---­----------------------- ­­­ - ----- ------------ ---------------- ......... <br /> S'ptiE-T&iTk-(S-p6c-if;'-Requirements)------------------------------------........... ------- 7- . <br /> .1111. i �I � ..........4--------- ...........------------- ------------------ - -------- ---------------- --------------- --------------- <br /> Disposal Field-(Specif.y Requirements) -__-------- <br /> P1 7 ------- ...­.................. <br /> , _...1.N ----------- ..........................I................ ......... . .......L------------- ----------- ....... ................ .......... . <br /> ---_----------- <br /> ------------------- <br /> ------------ <br /> 1 t (Draw existing and required addition on reverse side) <br /> 4-4 Joaquin County <br /> I'Ahereby certify that I have prepared this application and that the work will be done in accordance with San Jo <br /> F i a agents <br /> Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health Distract. Home o-wrier or I c nsed <br /> signature certifies the following: <br /> 1i - - . person in such manner as <br /> I permit is issued,L I shall not employ any pe <br /> 'I certify that in the performance of the work fbr which this p. , . X <br /> �' N �1;�' _, � , --f California." <br /> to become subiect to Workman's Compensaticm laws 0 U <br /> Signed._.._... <br /> -------------- -------- <br /> - <br /> .......... <br /> _ Owner <br /> - 4-e ------- ------ <br /> .. A. <br /> (/otheAhan owner) <br /> FOR DEPARTMENT USE ONLY <br /> ----- •------------- ------ DA . <br /> e V. <br /> .......... .... <br /> APPLICATION ACCEPTED BY <br /> DATE_......... ---------- <br /> blVISION OF LAND NUMBER---------------- ------ ---------------- --_-------- - --------------- -----------_------------- - ------------ ----------------- ------------ . ...... <br /> + ------------------*---------------*-------------------------- <br /> --------------------•-----•- <br /> I <br /> -------------- <br /> --------- -------- ------ <br /> ADDITIONAL COMMENTS_ ............ ------- ................ <br /> ----------------------- ............ . .........I—...... ------------ ................ -----------------I--------­ <br /> ......................................... ------------- .......... <br /> Ij .......I------------- ..............I------------------- <br /> ----------------------------- -----------­.......... ........... ........ 4----------------------------------------------------•-------- <br /> II - - -------------- <br /> 4...... ------- ............................ --- ----- <br /> :Final Insptitfion by:.... F&S 21677 REV. 7176 3M <br /> ........ ------------------ ------ --------- -------- ----- ­Date._/ <br /> $H 13 24 SAN JO UIN LOCAL HEALTH DISTRICT <br />