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FOR OFFICE LISE: <br /> APPLICATION FM SANITATION POW <br /> .................. ............................... Porrnit No. <br /> -1"d- 7J <br /> IMA..................... Date Issued ............ <br /> ................. ..................... 0 This 10mmit Expires I Year from Daft Issued <br /> Application is hereby made to ti� Son Joaquin Locol Health District for * permit to construct and Install the work heroin <br /> described. This applica4tion is pliance with County Ordinance No. 549 and existing Rules and Regulotionst <br /> 710 <br /> JOB ADDRESS I ....� I .. ­ � ...* ... ..........CINM TRACT ................. ........ <br /> ;Vy <br /> .... .... _1Y <br /> Owner's Name ...... . . . A .................... ......I.....phone ......... <br /> . . ... ...... ........... ...................................... <br /> Address ....... .. . ... -0 -S <br /> Contractor's Nomee .. ........ ........... . .... ... <br /> ........0�........Lim" #20:73Y3..... phone .Ak7F ...... <br /> Installation will serve: Residence Awtin- 0 COMMSMU4 oTrallor Court 0 <br /> Motel Other'.. ...................................... <br /> 0 <br /> Number of living units:.... �Aktlri W .............. <br /> b ....... ........ .....Of./ <br /> fdroorns Garbage Grinder Lot$Ize ........ <br /> Water Supply: Public System and name ....................................................... ......... ............................Private JA <br /> Character Of wil to a depth of 3 feet:- Sand 0 Silt[3 Clay C3 S Clay Loom <br /> Pow 0 andy:Loani',1K�; ; <br /> i��...... ......... ............ <br /> Hardpan 0 Adobe 0 Fill M6WW............�14' <br /> '"4611S,-T �C. must <br /> (Plot plan, showlnj�ige,'�kf lot, location of system in relation *64AIngs be plaicecl on reverse side.) <br /> NEW INSTAMATION:, (N64*t1c tank or seepage pit pormiLftd Vic; sewer is available within 200 feetJ <br /> PACKAGE TREATMENT IC TANK 0( <br /> $EPT ....... .. mz;� ..........I......I..... Liquid Depth .......................... <br /> ,_i Co Typ .... No. Compartments ...................... <br /> Qfstance to nearest: Well <br /> :S�......Foundation ...... ... Prop. Line ...................... <br /> A <br /> 0 no- ......... Total Longth ............... <br /> LEACHINGLINE No. of Lin Lovwh4 <br /> es ......3;............... <br /> D' Box ......L00111 Type Filter Material ....,Depth filter Mater I ......../Af.. <br /> ...... to ........................... <br /> Distance to nearest: Well ..... ...... Fou ation ...../19.'t........ Property Lim + <br /> S PAGE PIT ...... No 04 <br /> EE *A Depth ... Diameter ...e.-A...... Number ........�3.... .... Rock Filled Yes <br /> I � 'A 1(a 11/1.11 <br /> th-1. -X-... <br /> 001341% ......... ................. .......... MJIUK Size ..............--------- <br /> > <br /> DTianc� to nearest: Well . ....... ............ ..tf <br /> OU __ZA-'-t...... Prop. Line ...: .....t........ .z <br /> RIPAI <br /> L/�tMITION(Prov. S�nitation Permit# ........................... ................ ........ ......................... <br /> Septic 4ank (SpeckfyRecipirements) ................... ........ <br /> D pa' I Field JSpecify Requirements) .................. ..... . <br /> is $a . ............... . .............................................................................. <br /> ............................................... <br /> ................. .........................................................I........................ <br /> ................. ........... ... ... ........................................................................................... <br /> -------- ------------ -- --- <br /> ------------------I-Draw-existing-a-nd__requiri. <br /> ------ i4clition on reverse side) <br /> �wtlfy that I have prepared this opocation and that rw work will be done In accordance with San Joaquin <br /> unty Otdinances, State Laws, and-We$ qiidcltp <br /> gulations of the Son Joaquin Local HoaW 04VId.Home w or Ncw <br /> sod agents signature c*difi*s the j �Vwf- <br /> "I certify !hot in the Performance of the work for which this p*nvOt Is Issued, I shM not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of Collfo�nla.ff <br /> Signed ...... ....... ­............. ---------- --- ......................L Owner <br /> litle <br /> Ic" ................................ <br /> -- - ------- ­.........04 <br /> By .... ........ ................... ........ ....................... <br /> t(Ifother t i ' owned <br /> FOR DEPARTMENtUSE ONLY <br /> APPLICATION ACCEPTED By_.�_ <br /> 0 <br /> . ........ .........­­..................... -----------*­-------- ........ DATE ..........I...................... <br /> BUILDINGPERMIT ISSUED ........ .......... ..................................................................._........ .......DATE --- ...................................... <br /> ADDITIONAL COMMENTS ................................................................................. <br /> .................... ......._............ ................................... .......................................­­.................................. ...................... <br /> ........................................... ------- ­-------- ----------------------------------------------------------I.... .................................................... <br /> ...........I...................... <br /> .............. .................­­.......__......­........ <br /> Final Inspection by: to ...........I......... ............... <br /> �Z. ... �4_ 5 ........................................ ............................ <br /> EH 13 2h 1-68 Rev. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />