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rvx carrtC VSr: <br /> APPLICATION FOR SANITATION PERMIT <br /> ._.. Permit No. .76�. � <br /> (complete In Triplicate! <br /> .................................. <br /> ....... This Permit Expires 1 Year From Date Issued Date Issued ................... <br /> po v►!:• a;�:(Y1 ' .� .� .. �Zr7.._ O t-fpr-�f� <br /> Application-it,hereby made to the, ri iaoaquin 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 Regulations <br /> t MANDELVII-LC / cArJ Clem <br /> ...---- ......--•-•-. pp <br /> JOB ADDRESS/L ATION ........ N. � ._..^........�...........�................L-..-..... .CENSUS TRACT !• ........... <br /> Owner's Name .... ...... ......... '} N_.................................... ...,............................. ....__.Phone .................................... <br /> Address _ �. r-�...-�a x---......Y.S.7........5'rD.._CK7CJ .....city .........................................................• .......... <br /> p <br /> Contractoks Nara® ...R.OTQ......r �����..........................•------------License # ........................ Phone .......................... <br /> Instollatibn will ser. J Residence C1 Apartment House❑ Commercial❑Troller Court 0 <br /> Motel❑Other 1-19Bd CRMP e9M-P 27 <br /> Number of living units:....---..... Number of bedrooms ---- Garbage Grinder - -•------- Lot Size l7 e(`r ............+ <br /> Water Supply: Public System and name ..................................-----------..--------- ---..._......------------......-.................Private � l <br /> '- <br /> Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat 9�' �Sandy loam ❑ :Clay Loam ❑ <br /> Hardpan[] Adobe❑ Fill Material . if yes,type................ ............ <br /> Tlot plan, showing size of-lot,,location of system in relation to wells, buildings, etc. must be placed on reverse sid' <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,! <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-1 ] Size................................................. Liquid Depth ...................... <br /> Capacity .................... Type .................... Material....................... No. Compartments ................... <br /> Distance to° nearest: Well ... Foundation Prop. Lina ................... i <br /> LEACHING LINE [ ] No. of L�Ines..... ngth of each-line....:...' .............. Total Length ....................... <br /> „r D .- <br /> Box,..............=Type Filter aterial ....................Depth,Filter Ma rias ._,....................................._ <br /> istance to nearest: Well .... ... Foundation Property Line <br /> SEEPAGE PIT Depth ::-=: ;--;...... Diamet ...............• Number ......._ ......._.......:. . Rock•'Fllled Yes ❑ No <br /> ,.........�,. Water Table~Deoth ............ ...............................Rock Size .......... ................ <br /> �• Distance to nearest: Well .. ................................Foundation ......... Prop. Lina ......................CS <br /> REPAIR/ADDITION(Preir: Sanitation Permit# ........... ------ ....................... Date .................. <br /> .. ............ <br /> ) <br /> SepticTank JSpecify.Requirements9. ...-- ................................... ...................... ............•....................... ............._.._.._........ <br /> Disposoi'Fielai (Specify Requirements) (Q_TL 1477-1.N.�.."M.'77.9- K:...'4- <br /> f�:D.J�1ST. Z? R.�3A <br /> ....... z-lQ_ �R.L .....z ..: -.;r'a--`-------F-,iLT Ei:IBE- <br /> ` -v IV PISTI.AOX _ X 8 .R 1►•«t <br /> - (Draw existing and required addition on reverse side <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Jeaqui <br /> County Ordinancesi,State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify in the perform ceaheark for which this permit is issued, I shall not employ any person in such mannas to be subject to War nsation laws of California." <br /> gned .......!...... 4..................... ..... Owner <br /> By ................... .. -•..............---...............-------•---.._..T...c��:©. Jitle ................................................................--_..... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... <br /> 1 �P�,...................... ..... <br /> ........... <br /> ... ................ <br /> ...........-••......r.......................... DATE........ <br /> .7n o.Z.'., ...�.... <br /> BUILDING PERMIT ISSUED .. .DATE,_ L <br /> ADDITIONAL COMMENTS ..... .... .............. .............................................. <br /> .--.............-.......:................................... <br /> . <br /> ... <br /> ----•... ..........• ---...--.. .. .... .. --......-....................---•........................ .----.. ....----........---........--•--........... <br /> --..... .. . �. <br /> ..... <br /> Final Inspection by: ... .�... .... .. �................... .. ................•---Date ..... . 4 ~......... ......-. <br /> 04 13 2h 1-68 Rev. PL <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3l <br /> CAl <br /> i <br />