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FOP, OFFICE USE- <br /> 17 °m �- �,wmrPL»C»�n��«� FOR SANITATION PERMIT ' <br /> ��«���mo�����W��e� Permit Nn <br /> ' <br /> This.permit Expires I Year From Date Issued Dote Issued <br /> Application hereby made tuthe Son Joaquin Local Heo|/6 District for o permit +oconstr � and install �h <br /> oe�z/oem /napplicationi od | 7 +H � '-- - --`~ herein^ <br /> U 7s To <br /> Address %P A Al 4� <br /> Contractor's Name I"-211119MA <br /> . -\y------ __-'-_---__'_--,. se_ ~-.-.._~'--7---- Phone ',c'�'.^.-�'---'�'-­- <br /> i <br /> Installation will serve- Residence []Apo rtnenf House Comm amcio7oTrqiler Court �] <br /> A8omm| E]Other <br /> Number nf |ivhoQ unita----//- Number of bedrooms --'';9��-Gor6oge Grinder ------------ Lot Size -t-A-[~�Y4-�-------- <br /> ' vvoter PuEJb�ya�ynon6nonm� <br /> Supply: --------------------------------------------------------------------------------------------------------------Private <br /> [] <br /> ' Cho,octerofsoil tmodepth cf3feet: Sand E] Silt E] [1oy [] Peat E] Sandy Loam Clay-Loom[] <br /> Hardpan E] Adobe-[M Fill Material ------------ If yes,type- ------------------------- <br /> (Plot <br /> ------_---- � <br /> .. _. plan, ~.~w".y ""= of .=.' location or system in nn|ut|on to-wells, buildings, etc. mum be placed on reverse side.) Q$ <br />.� NEW (No septic tank or seepage pit permitted if public sewer ioavailable within 200feet) <br />�. <br /> PACKAGE SEPTIC TANK /� |qui� ��c� /�^� � <br /> Vr- <br /> � / ����������--_-_- , . '~ -------- ��pocV� ^/�L� � T� �� Material /�/���/�p� <br />� -' --- �- p� ��'������ -'---- No. Cpnmpmrtmenv . --'�----^-- <br /> Distance to nearest: VVe|| y~ /7 ' Foundation »-�� ` / <br /> -'��'°"_-_-------- u�do�on ---_-_--- Ppop. Lina ��'�-���_'-' <br />| <br /> LEACHING LINE W of Li x/ «�(7 / / <br /> " Box ---^ -- Type Filter <br /> � x-~o-tawr'k/x :ig' - -' '�5- Depth Filter Material -.---' ' <br /> Dishxnce to nearest. Well <br /> �-'�-_'- Foundotion ------' Property Una "X --------------- <br /> SEEPAGE <br /> '''--SEEPAGE PIT [ <br />| ------~---' ] Depth ' - ---- D�oo��r � ' Number �/------' Rock Filled Yes ~u No <br /> . <br /> Water Table Depth -----��-�-�---'--_--_-..--Rock 8�e -'�.��--_--'' <br /> ^ D|mnncetzneoma� VVeU �»^ ----' �~� <br />. -----------------------Foundation ---- Prop. Lin -------------------- <br /> (Prev SonUoMom Permit ------------------------------------------ Date ---------------''--'-----) <br />� <br /> Septic Tank (Specify Requirements) �~ <br />� -'_��_-'--'---'--__-__'--��-_-_'---_----'---�--'-'_'----_'-------�.--'_ <br /> ------------------------------------------------- <br /> ,~------� _ <br /> (D w existi g a iid�/requ d ditio 11 le <br /> ad n on reverse side <br /> I hereby certify that I have prepared this application and that the work will be done�in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed.agents signature certifies the following: <br /> "I certify that in the performance of the work for which this <br /> permit is issued, I shall- not employ any person in ~~.~ ~===== ` <br /> ACCEPTEDas to become subject to Workman's Com en tion laws of California." <br /> (if other than owner) <br /> R DEPARTMENT USE ONLY <br /> BY-' <br /> DATE <br /> --_�'_ PERMITISSUED <br /> � <br /> ' ~~ =`"^ C`=. vEmm <br /> - ---- --- - ------- - ------------------------------------------------------------------------------------------�y------- ------- <br /> Rnol |nupecMon6y " - - '^''--��m��---__'--_---_________^___ ` <br /> ' '—'---- ' D��, <br /> --------'-_-----.____________ ------ <br /> SAN <br /> _SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> E. H. 9 l'\68 Rov. 6M. <br />