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1 ) ,e w Tn,5-ICE LjS- <br /> A7 yah <br /> (t'�j y��;� �r• -',PPI.ICATION FOR SAN.TATION PERMIT <br /> ICompfate 7,�_�,Z <br /> in Triplica►e3 � �+ <br /> af, <br /> This Permit Expires I YearFrem Date Issued <br /> { Applicoticn is hereby made to tha 5^_n 1onquin Loco` Health District fora permit to construd <br /> # described. This a,7alication is mode in cornnliance with County Ordinance No. 544 and exisftnr4'pul d'P'y—vIc!Ions�� <br /> JOB ADDRESS/IOCATIIDt+ `/ 'i <br /> Owner's Name C�-c ; <br /> / // CENSUS Ti" '7 <br /> `'fZ ............................ .. phony <br /> Address s <br /> �� `i' . ... ....... ..... .-.. Cil • <br /> Contractor's Name 4� t^4 -�- _y %.{- �t•.. <br /> License -3 Phr, <br /> Installation will serve: pesirrer.e ❑Apartment House{] Commercial ❑Trailer Court r-7 <br /> ti '"o.ei 0 Other / 1 <br /> m <br /> . ... .... .:r Loi Sire <br /> Number of living unify: � Number �•-r o• bedrooms . .,,,,,Garboga Grind-:r ..� _» •--- � <br /> Water Supply; Pubic System and nor".:! ; <br /> Character of soil to a depth of? feet: Sand $ift <br /> ❑ Cloy ❑ Peat❑ Sandy Loom ❑ Clay ^_aM. <br /> t <br /> Adobe ❑ Fill Materia! If yes.type . <br /> (Plot plan, showing size of lot, locciion of system in relation to wells, buildings, etc. must be placed on reverse sido.)� ' <br /> NEW IFISTAIsr!TION: <br /> _ {No septic tan)-. Crcr see age pit permitted if public sewer is available within 200 +eet,l s <br /> PACKAGE TRE:„-MINT SEPTI ' <br /> 1 si c TnNr i siza., �X/ : . �, -� <br /> r Liquid Dept:r <br /> Capacity iL. ,�` Type •n•• c... Material,�� No. Coinpartm'nts �.. ........ <br /> 5 1 , <br /> Distance to rc❑rest- Well Jb�. J.. Foundation , ( G�. Pro o. line 5. .�.... E <br /> �/ ...... <br /> LEACHING LINE (Pr No. of Uries � Length of each ling Total Lengt}: J Z� � 7�' ' <br /> .............._. I <br /> D' [ .c f Type Filter Malerial ...S.i�i ......Depth Filter Material /10' :j <br /> ......... <br /> Foundation 10.'...... Property LiaE 5 . ._... <br /> J Elatanrc ;o nearest; Well .. �� ` <br /> SEEPAGE PIT (L Depth �.? ' •• - ry <br /> p Diameter ... .>k......, Number .3 Reck Filled Yc.s � No Q ' <br /> Water Table Declit ��?..�....... Rock Size ......�.� �� 3. y <br /> .... ........ <br /> s i <br /> � 13istance to nearest: Willi �f�,Ca.....................Foundation . ../.0 + Prop. Linn . .. ................. : <br /> ' REPAIR/ADDITIOM iPrev. Sanitation Permit# ........ Dote ..... ........ <br /> v <br /> ' <br /> S+! is <br /> . I?t Tank 1 5 <br /> pecify Requirements) ................... ...... 3 <br /> DiSposol Field (Specify Requirements) _ .... ... .. <br /> ' 1 <br /> (Brew existing and required addition on reverse side) <br /> I hereby Certify that 1 have prepared this appliratiort and that the work will be done In accordance with San J"gWA <br /> County Ordittencos, State taws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or 11cow <br /> sad og*nts sig.tature cortifles the following: <br /> "I certify that in the performance of tho work For whit%this permit is Issued, I shrill net employ any person in such matseer <br /> as to become subject to Workmen's Cor ronsallon laws of California," <br /> Signed n t 7.. ...... ... ...... C••/ner r <br /> By ` • !.,, ,.f /(.1 t x�a-�t.��.f- . Title <br /> IIF other than owner! <br /> I <br /> FOR R DEPARTMENT USE ONLY <br /> APPLICATION ACCEP cD BY C DATE �1 - <br /> i <br /> BUILDING PERMIT ISSUED / , D E <br /> ADDITIONAL COMMENTS <br /> �. <br /> final Inspection 6y: � <br /> it ..Date y�',� 7 <br /> ` ',�� .10AQ0N LOCAL HEALTH DISTRICT <br />