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FOR OFFICE'USE.. N PERMIT <br /> APPLICATION FOR SANITATION Permit No,. -0-, )---------- <br /> ---------------------------------- -------- ---- ------ (Complete in Triplicate) <br /> ---------=--------------------------------'-----,---- Date Issued -------- <br /> This Permit Expires I Year From Date Issued <br /> I the work herein <br /> Application is hereby made to the San Joaquin docal Ko%alth District for a t t construct and install <br /> W, � f/ p r <br /> e in co with C t,Ord' a N�;)&Inod existing Rules ndRe cations: <br /> Ord' <br /> YO <br /> described. This applietio is 00 T <br /> r+D (Y. <br /> T <br /> -------------- ---!7-,-- <br /> L _r .. <br /> 1-19 _fP_CENSV�TRACT <br /> ZX-FS _ j <br /> _p <br /> jOB<jaUUS&�?6NTION ----------------------------- ------------- --- _ i <br /> j ----------Phone <br /> Owner's Name ----------1:?VY-------- Z��---- ------------------------- <br /> Address ------ ----------- City -----/00 ) S7�0____---------------------------- <br /> ----------License # --------- <br /> Contractor's Name ----oww f� ------------------ ---------------[------- --------------- Phone <br /> installation will serve: Residence ��ent House�El Commercial OTrailer Court <br /> Motel F1 Other -------------------------------------------- <br /> Number of living units:_, - ------- Number of bedrooms A____.Garbage Grinder Lot Size <br /> Water Supply. Public System and name ---------------------------------------- -------------------------------- ---------------------------------Private <br /> Character of soil fYddLptH—f-3-f&-f—Sdnd-o—Silt-O—C� Y' <br /> ' F&-t <br /> 7 — <br /> Fdylo— E —CITL—oc—m <br /> Hardpan 1 Adobe SII Ma f ,2F---- -�-�— <br /> Ytype ---------------------------- <br /> �_7 <br /> (Plot plan, showing size',of lot, location of system in relation to-w,:ei4­s-bvi4cfings-e.tc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepc,3,�p r itted lif public sewer is available within 200 feet,) <br /> SEPTIeTAWk Size-X. <br /> Liquid Depth ----S--------------------- <br /> + Capacity- p- --SypeCAMaterial_ �PACKAGE TREATMENT L 4� — <br /> N 0! Compartments <br /> .... Prop. Line <br /> istance to nearest. Well io <br /> ----------Founclat <br /> ichL line otal Length <br /> tEACHING LINE [i �JNo. of Lines ------ --------------- Length,,of <br /> k ; ;�,j , (ff Zi Q_ lo, <br /> L P)t5�4--bepth Filter Material ------------ --------- -------------•- <br /> Distance <br /> ---- ...... <br /> '13-tox­6 $)7�pel-PlIte __1 R <br /> Property Line <br /> =_,Founclation I------ <br /> Distance tyn crest: Well <br /> if V ` Yes 0 C] <br /> 'Oo Number!------"2-- -------- -- Rock Filled <br /> 1!------ Diameter <br /> SEEPAGE PIT i Depth _/ <br /> 1 1 <br /> Water Table Dbpth ------35- -----=------ ---------------Rock Size <br /> ._-___Foundation Prop. Line <br /> Distance to nearest: Well ------ <br /> ------ Date ________.---___-.- <br /> rs <br /> Se <br /> (Prev."Sanitation er", it#;--------------------------------------'----- Date <br /> Tank (Spe6fy lie ullrements) _4 °-------------- I------------------------- <br /> --------------- <br /> Disposal Field (SpecifyRequirements) �--------I------------- --------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------I------------------------I------------------------ <br /> -- <br /> ----- <br /> ---------------- ------- ------ --------------- -------------------------------------- <br /> J ---------- ------------------------- --------------------- <br /> -------------------- - <br /> -----------T ------------------------------------------------- <br /> - <br /> ---------------------------- ------- ------ . n reverse side) <br /> r (Draw existing and required addition o <br />• I hereby certify that Ehjave!lprepared this application and that the work will be done in accordance with Son Joaquin <br /> County OrcIfincinces-,, t laws, and Rules and Regulations of the Son Joaquin Local Aealth District. Home owner or licen. <br /> sed agents�p atjj 'ce lesthe following: <br /> .11 �rtj ` k. :i 4'd'rQ4khNhis permit is issued, I shall not employ any Person in such manner <br /> certify <br /> ha <br /> _In <br /> ce in t,h pe o.r of the'lwork <br /> as to be&(e suble, to -a is C L; ffj <br /> O -sbtloawof California." <br /> Signed -- --- - -- --- ------ ------------- •-------------. Owner <br /> By ------------- --------- ------ Title - <br /> ------------------------------------ ------ --------------------------- <br /> ----1� ---------------------------------------- ---------- -------- <br /> (if oth,e(3th.an owner) <br /> --FOR-DEPARTMENT-USE-ONLY� <br /> APPLICATION ACCEPTED: BY ----- - -------- ------------------------------- ----------- ---------------------- DATE <br /> 7- —DATE ------------- ------------------------- <br /> ---------------------------------- <br /> BUILDING7PE9MITiSSUED ............. --------------------------------------------------------- <br /> ADDITIONAL COMMENTS 0 r. .01 r4 11-71,-' 0 _- .;/t r� , �� L,-------------Z�!�------------------ <br /> ---------- --------------- -— ---- --- -=` -- -—--------------------------------------- <br /> ----- ------- <br /> ---------------- <br /> ---------------------- ----------------------------------------------------------------------------------- <br /> -- <br /> ----------------------------------- --------- ---------------------- -- - --------- ----- - -------- <br /> -- --------- ----- -- - -- ---- --- --------------------------- <br /> -------------------- --------------- <br /> Date - <br /> Final In ------ --------------------------- <br /> - - ---------- ------- - -- - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1268 Rev. 5M <br />