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-------------- <br />N FOR SANITATION PERMIT <br />� ^ ~ <br />(complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />� <br />, Pen, i tNo�.����-�'�� <br />Date Issued <br />| <br />Application ' made to the Son Joaquin Local Health District 6x o k � <br />�o construct and nmoU the work herein <br />descrbe6-Tf�x application |omade |ncompliance vwhhCounty Ordinance |4c` 549 and n6Regulations: <br />7,111 <br />^--r ZCT ' <br />Con,nz,xorqName --- ----- ^�^���..^72-.-^5,_49,�°~.-------------- License "' <br />|nstaUoHun will oe,vo. Residence ZAporhnenY Homse�F] Commercial -[]?roi|orCourt ;E] � <br />Motel F-1Other ,.---.---'------- <br />Num6arof living vnho`' �__ Number of bedrooms �Z---- Go,6ogeGrinder AA^- Lot Size .- �- ----------- <br />---VVWater <br />oter Supply.. Public System and name ------------------------------------ -------------------------------------------------------------------------- <br />Character ofsoil toodepth of3feet.. Sand'[3 0|+J-] Cloy E] Peat El Sandy Loam[] Clay- <br />Hardpan [] Adobe,(-] Fill Material ----- ------- |fyes, type ---------------------------- <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />NEW INSTALLATIOUN, <No septic tank o, seepage ph permitted if public- sewer is available within 200 feet) . <br />* <br />PACKAGE TREATMENT [] SEPTiCTANK'[jd Size --- d,_y�"-- ~----.-.- Liquid Depth --- ^'�'?-�°--'--'_- <br />Cupoci'''mwfer|u| Compartments e7---~ ......... <br />. <br />Distance to nearest.Well ------------------------ Foundation /gF/------------ Prop. <br />|�( <br />Une__.-'_--'�� . <br />' <br />LEACHING LINE �^ No. of Lines --------- /---.. Length uf~'each knw—. -�-—' Total Length <br />~ '-�'�.�=-. —�'—_''~- <br />D' Box A/P/Type Filter Material .--_Dopth Filter Material --- �°^r_--r_-''_ <br />Distonce to nearest:Well '^r-r�-7---------- Foundation -------------- Property Line. .J ................ <br />/~ <br />SEEPAGE PIT Depth -/ Diameter '� �.' Number --------�------------------ <br />Rock Filled yesJ���� No� <br />---_-___-_ ��-^-Diameter-- <br />/ � - «~ <br />Water Table Depth .�r�,.���--.-------.'_JRock D�e + -- <br />Distance to nearest: Well � ._----..Foun6ahon _/0 ............ prop. Una - �-� -'-�~-^ ' <br />(Prev.Sanitation Pemnitv¥-------- ----------------------------------- Date --------'--J <br />^ �� � <br />8op�cTank �pncifyReqvimmenm) -�-----�-----_.—._'--'-_---.-_'^'_---'--_-----'---' <br />~ ^ . <br />Disposal Field (Specify Requirements) -----_---------'-------------'-------'-------'----- <br />` . <br />--------------------------------------------_--- . <br />` <br />--------------------------------------------- - . <br />---------------.---' <br />W . <br />(Draw existing and »�nuiredo6JNonon,evene�Je) ' <br />I hereby certify that U have prepared this application and that the xvoHx will be done in accordance with Son Joaquin i <br />County Ordinances, $mavm Laws, and Rules and Regulations of the San Joaquin Local Health District. Home mwpmw, or licen- <br />sed agents signature certifies the following: <br />"| certify that ;n the performance of the work for which this permit is |wwwed' n shall not employ any person in such manner � <br />as to Ab/subi Workman's Compensation laws of California." <br />Signed - ---------.-._------- Owner <br />By---------.—__'------�. Title-------------'--,--'---''— <br />