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FOR OFFICE LOSE; <br /> APPLICATIOW FOR SANITATION PERMIT <br /> ............. ...W. ... ................. <br /> (Complete In Triplicate) Permit N&. .7 <br /> P*Mi <br /> This t ExExpiresI Year From Deft IswW Date .................... <br />............. ............---------- ................... <br /> -_Appikation Is hereby made to the Son Joaquin Local Health District for a permit to construct.and Install the,work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> JOB ADDRESSAOCATION e�16 ...Q.....................................CENSUS TRACT <br /> . .. ....... ..... <br /> Owner's Name ....... ...... .................................... <br /> ...............Phone .......... <br /> . ............ ................. <br /> Address 1.b.......... city ... ................................................... <br /> ..5t- <br /> Contractor's Name ...........r4tZAo--),-0-c--4-A...41f.... - ................ ........License <br /> Phone 6.7f <br /> Installation will serves Residency (Apartment House 0 Commercial oTrallor Court [3 <br /> A4A4-13 Odw <br /> Number of living units,...11... NurrAW of bedrooms ....G�rbago Grinder .... ....... Lot Slx* ..........4b ........................ <br /> Water Supply: Public Sy nano y ......,..=.... f ................. ..............PrIt.01010 0 <br /> Character of soil to a depth a,3 feats Sand-0 Slit 0 , -Cjay,[2 -Peat a Sandy LIAM, Clay Locrrn <br /> Hai_ �O Adobe 0 Fill <br /> Material............if yet,type............................ <br /> !Piot plan, showing size of Kett, location ofsystemin relatlr*wolls, buildings, etc. must be pkwed an reversesklo-V <br /> NEW INISTALLATIOW 4NO stptic-tank-� If twMic sower Is avalla'61 e within 200 foet.) <br /> PACKAGE TREATMENT <br /> SEPTIC TANK f ............. Liquid Depth <br /> nn <br /> Cop odty .Pw <br /> ��Wpl_ . Material...Crz <br /> .14 <br /> ..... <br /> No. Compartments 47*1.........4- 00 <br /> Distance to nearestt Well ....... . ..... . I -i <br /> ---r............Foundation ...Z40--/ .... Prop.Line <br /> L <br /> 4 <br /> LEACHING LINE Na. of Lines ...... f0h, pch line ............. Total Length .............. <br /> V Oak ....��. Type Filter M Depth Filter Material ........6? <br /> ........ . .. <br /> Distance to nearest. W611 ..... ... foundation ..... Property Line ...........2... <br /> ..... <br /> SEEPAGE PIT O Depth .................... Diameter i ...... Number ............................ Rock Filled Yes 0 No (:3 <br /> Water Tabl� ................1 <br /> ........................... size ...........o................... <br /> Distance to st, Well ..................................—Foundation ........... ....... Prop. Line ........».......,.......... <br /> REPAIR/ADDITIONIPrev. Sanitation it# ........................................... Dam .............. <br /> arm I <br /> Septic Tank (Specify Requiremen ........ ......I................... ......_. , <br /> C%l <br /> 0" <br /> Disposal Field ISpecify Requirenents) ...................... ... . ..... . .... . ... .. ............. <br /> A <br /> ................ <br /> ..........................................................I ..................... . . ..... <br /> .................. .... . ........ ...... <br /> .......................................................... .... ............................................................... <br /> - ��Ii�racl�dltlon on reverse side) <br /> r'o—w----existing i'n-96-and q-u-I' .... .... . ..... ... <br /> I hereby certify that I have prepared this application and that the work will be done in accoidance with San Mils <br /> County Ordinances, State Laws, and Rules and Regulation of the Son Joe"* Local He District. No" owner or NCW <br /> sod agents signature cortifts the foli- <br /> "I certify that In the performance of the work for which this permit Is Issued, I :bail NO#*0400Y ONY PWSON IN S"6 104100W <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ........ ............... . ------(7-1.... .. . . ....................................... Owner <br /> n. .................................................... <br /> BY ............. .. ot....r ........La <br /> . .I Title ...........11;Lan o--nr) ......... -------------------- <br /> APPLICATION ACCEPTED BY -- <br /> ............................. <br /> . DATE ...... . ..... <br /> BUILDING PERMIT ISSUED ........L-............. ...................... ....... ...........I <br /> ADDITIONAL COMMENTS .... .... .................DATE ..................................... ...... <br /> . ... <br /> .............. . .. . ..................... . . .. <br /> .............................I...... ....... <br /> b <br /> nspection y: ............ . ......... ................................Date. .. ...vf......*'��............ <br /> ..................................... ...... ....................... . ........0 ........ ............ ........................................... ....... ................ <br /> ............. ............ .. . .... ... . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> rj.LI3 241--A,& <br />