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APPLICATION ICOR SANITATION PERMIT � _ <br /> Permit No. .`'�`.w...1�'�. <br /> (Complete In Triplicates Y <br /> ..... ......... ..... .... ... This Permit Expires 9 Year From Date Issued Date Issued . <br /> Application Is hereby made to the San 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 /> i A ,� tr n� <br /> JOB ADDRESS/ICKATION /7,500......Y*.!__.._.`��..[Y-._.. OST <br /> ...CWi 1S TRACT :.-... <br /> Owner's Name ...... :G-°F7-(7J �....Phone .................................. <br /> Address .... f J��_ .MM.F�............ .Ci i .-...`..t'.!7 - ....... <br /> fir <br /> Contractor's Name ~. License # .......... <br /> .*. Phone .............................. <br /> { <br /> Installation will serves Residen�ortm Ho Iwo Commercial❑Troll Court ❑ <br /> Motel ❑Other...I...... ................. <br /> 9 • �1 <br /> Number of living unit$:....--...... dumber of bedrooms Garbagai Grinder A�S �T <br /> Lot Size CKr=j9-6-.1;.F1............... <br /> Water Supply: Public System and name ` I l ..........Private <br /> .. ....._ ..:................._............. .................._-_..... <br /> Character of soil to a depth of 3 feet. Sand b Silt 0 Cloy ❑ Peat Sandy Loa+jvQ Clay Loam 0-1 <br /> ii <br /> - Hardpan ❑ Adobe 0Fill Materiatl' .1�.....if yes,t+ype............... ............ _ <br /> (Plot plan, showing size of Ibt, locat an of system In rela ion to wells, buildings, etc. ;Aust be placed on reverse side.) <br /> W f.. <br /> NEW INSTALLATION: (No septic tank or seep pit pern0tted If public sewer is available within 200 feet,( <br /> }} <br /> PACKAGE TREATMENT [ ] SEPTIC TAMC `Size-- _ , q p . .. _.. ... <br /> Y_ ..••-•---____-. Liquid Depth <br /> Capas;t t �Z- - --- Type ,_Materiallo. Compartments J <br /> t" _.__: _ .__ <br /> /,Distance to nears: Well .... .Q.. ..._ Y un ation .Ae.'.��.... Prop. Line -..�L7___------� <br /> .�Fo <br /> LEACHING LINE�--.[ . No. of Lines .....� ................ Langth of each I a.Q... ..... o�ai Lyngttl ......'�7.-��.. :t`..0 <br /> f '.. <br /> LTI 'rB ,�s D' iox ` Type Filter Material C epth Filter Materlal ... ......................... ......... <br /> O t Vol r <br /> Distancb to nearest: Well ...1494 ............ Foundot on /p "'� ... Property Line <br /> . � f <br /> SEEPAGE PIT [ ) Depth .................... Diameter ...- ........................... Rock Filled Yes ❑ No <br /> Water Table Dep jti ---...................�:...�.� ..... ack Size ................................ C <br /> ::_ <br /> -....� �s .....0 <br /> Distance to nearest: Well ' ............................•---.....Foundation .................... Prop. Line ............_.... <br /> REPAIR/ADDITION(Prey- Sanitation Permit# ... ............................•--...._ Date ..................................I <br /> Septic: Tank Requirements) ./..................... <br /> .. ............................. ....................... ............_-.---•........... <br /> Disaosal Fiefs (Specify Requlrame tsri ] ..... .............. ... ) <br /> ..... <br /> ` D 4.� ...7 ..t .:1rJ._. P.. l ....... ......................................................... + <br /> ....i. _...._._._17500 tN YOn( sore <br /> ........................... --_ . ---....------.-...-. <br /> ... .. ..... .... ------- -_ <br /> (Diraw existing'and.required audition on reverse side) <br /> I hereby certify that I have prepared f this application fnd,that the-work will be done In accordance with San Joaquin <br /> County Ordinances, Stat*Laws, and Rules and Regulations aIA-4 Siff iocOn Local „Health District. Hoene owner or licen- <br /> sed agents signature dewr`iifies the follo4ing: "19 V%W3 t'V40 11 <br /> '°t cerTiijirth �l=Te( Rperformance of tb fqr vyt:icfa.this,perrnitwts,issued,-I;shall not employ any person In such manner <br /> .-_. <br /> as to beta subj c# to r man' onsation laws off <br /> alifornia. <br /> " .. <br /> Signed .-........... Owner �L <br /> 8 i •- .... Jiffs ✓-�J <br /> YG-�• -,......... ........................... . .... ............................. .. <br /> llf..othe thab owner) <br /> J <br /> • v, IQ . <br /> i FOR DEPARIENT USE ONLY <br /> _APPLICATION ACCEPTED BYJ...... - .....,....... Vit!..._... ................. DATE ........ ....... <br /> BUILDING PERMIT ISSUED .. w....�... ....... �"....Y.. :........DATE ..... ........ ................. <br /> r.•s..4....... S -.. �.+a.r --. <br /> ADDITIONAL COMMENTS . (. .. -- 1 .. ..1. ''�'� , ',ir _.-..... I <br /> t. ................... ........... . ...................... <br /> ...........- ...... .................................. - ........ <br /> --.. ... ..... • . . • ---••- ...--... <br /> _...... ---•-----•........ ... ........ .... ..................------....... <br /> 4. <br /> .. -- . 7� <br /> Final Inspection y: . .............Date ...... ... .......-.............. ......-• <br /> L1 13 2L 1-60 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />