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[ <br /> FOR OFFICE USE: N-� FOR OFFICE USE: <br /> - z�W� �� APPLICATION FOR SANITATION PERMIT / <br /> -------• -- --------- - -- -------- Permit No.._ 7--. f?, <br /> (Complete in Triplicate) <br /> - <br /> ------ -- -- ---- --- - ----. _---.-.------- _..._ .- This Permit es Year m Fro DateJssued� .___ Date Issued_.• <br /> �ued- - -77 <br /> Application is hereby made to the San Joaquin Local Healt�h,bistrict fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> iJO LOCATION , : <br /> _-.-_-CENSUS TRACT;_______________________ <br /> one_-477 -1° lowner ............a Y. ' <br /> Address.................................- :l�r T/!2 .w CI ?achH .. - Zip <br /> { _ a <br /> Contractor s Name......_._....r. .</ .i r .EMS. 'i -. _.,w} rc_�-__.. License #.-94�gV3 Phone�.I.-�� <br /> Installation wilE`serve: i ' Residence�� Apartment House 0 Commercial ❑ Trailer Court Q y <br /> :.. . i..._.;.....,;...._.. .. , - Motel ❑ �OtHer-:_,-::_-- .-=r:_E:._..�:.::..:....:.,: %' + • -. i i <br /> Number of living units:__`_. :......Number.of,bedrooms; orbti inder.......... .L A Lot Size &R Q.. ;. ........................... <br /> ____ <br /> Water Supplyr-Pubiic_S-ystem_and.Home ::: i :----.:------- _ --- .......... ----- ----_ : -- -t--- - <br /> Character of soil to a depth of 3 feet: nd-❑--'Silt-L]! Clay❑ Peat❑ Sandy Loam n Clay Loam <br /> ~Hardpan Adobe Fill AAateridl__.. ' -.__If yes,type? _. .- ... j . <br /> (Plot plan, showinlg.size_'of_la-i, cation of system-i relation to'wells, buildings"etic. must be:placed on`reverse side.) <br /> Z, <br /> NEW INSTALLATION: -(No fank'*or seepage pi4 permitted if public sewer is available within Q00 feet,) <br /> s _ _.j._._ 'q. i r <br /> PACKAGE TREATMENT"'[")' SEPTIC TANK ' ["� f Size__:..:_:::_-'.:....:........ ....-----.:.:................ti uid'Depth'...-_-..._:-__ <br /> .........:..:.Type_....s_:::__._-_--_....Material------�,_.-.�.........._ No. Comoartinents-�-__-:':-----_---__---------- <br /> F VL <br /> .Distanceto nearest: Well_r,..,.., ;.._.__._-- Foundation.-___... Prop. Line_.....................F . <br /> LEAGHING LINE'''-f-:j—No-of-Likes.._-:-____ L-ength of each line•.,. :.•--_-:-':,-_ .Total..Length ---------------------------- - ---- <br /> , <br /> � f�.. F ,•/ � 'D Box_.. ._____--Type Filter Material____________________De;q�15 Filfi\� -'Material.-*: ; : - ---.--- -----• ---------_---- : - ------ ,-- <br /> ( 'Distance to nearest:Well_;____-'_____________'.____Foundation_:__-- --------------__-_Prop erty Line-,-____- <br /> . ... .�-_-• 1: �,. ,. � . <br /> SEEPAGE PIT [ ] Depth___.!___._ -__.Dia eter�._`...........Number.....__...:....�r.. y Rock Filled Yes❑ No ❑'' <br /> Water Table:Depth--------_--------- Rock Size-`-- ------- --- -- ----------- ' <br /> I Distance to nearest: Well........:......:........................... <br /> :Founda ion..._._-_- ---.-_----_- Prop. Line------------------.-----1-�a <br /> REPAIR/ADDITION (Prev:Sanitation Permit#-..._.._._::•_________________`:_._:_..____......_.:Date__... ._._____.._:_:..-.-_r__....;-_-....__:} " <br /> Septic Tank (Specify Requirements) -----: --- = jam_ F i - _.._. <br /> Disposal Field (Specify Requirements): Q -- - �;r... = `-- ---- ................ j <br /> C - ILA- <br /> (Draw existing and required addition on reverse side) <br /> : ► <br /> I hereby certify that I have prepared this application and that the work will b'Z •Pone' in accordance••w4h LSon Joaquin•County <br /> Ordinances,: State Laws, and Rules and Regulations of the San Joaqui� Loc6l Health District. Home owner or licensed agents <br /> signature certifies the following: % t <br /> .11 certify that In the rformance of the work for which this permit Is issued,`lr <br /> �shall not employ any person In such manner as 1 <br /> to.become ubiect t orkma 's Corn ensation ows.-of California.'.'. ... l J - �• <br /> Signed_:_..N'c.Q... f -• --- Owner. <br /> By}----- --------- - -........................ ... ..i_.. Title..__ - l <br /> (If other than.. <br /> R DEPARTMENT USE ONLY '►• * i� <br /> APPLICATION ACCEPTED BY...... --=L----------------•---------'--------}----.... .............. .....DATE........ ............... ..................... <br /> DIVISION OF LAND NUMBER.. __._..:--•-••-•____________________ -----L......... --•----•-- ._ _DATE............................ <br /> ADDITIONAL COMMENTS.... ... . ...... ................................ <br /> ........................ .- <br /> . <br /> .4cc�/ /lcs�r� r,.. . . <br /> - - ------ / b r _.... ...... <br /> r F <br /> ------ --------•-- -- -------•------------- ..... .. .. ----- -------------�--- ....?7� <br /> ---------------•------------- - . --- ................................................... - <br /> Final Inspection-by: - - :.t„��_``��...............................................�.• Hate r _� <br /> EH 13 24 / SANAOAQUIN LOCAL HEALTH DISTRICT FU 2" ien 161.r/�6 3M <br /> U J <br />