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FOR OFFICE i1SEt APPLICATION FOR SANITATION PERMIT permit No. . <br /> . ....................................................... (Grnplete M Triplicate) �y /•J�� 7 <br /> ' ��I� ........... i�issued/r^•l.T.Y`�'':`... <br /> } ,f,. .............................::._.......... This Penult Expires: Year Prem Date Issued <br /> r. <br /> permit to construct,and Install Lite.wokh <br /> Application is here made to the Son Joaquin local Health District for a pe ; <br /> with County t7rdlnana N 549 and exlstufss mid ReQalat '� <br /> described.This application Is made in compliance ^ s J7�iC, rO.l�f. TRA <br /> fJOB ADDRESS/LOCAQT�I�O�N ._•••-,- n.... '..................... ..............................•...Pl+one .. l6 <br /> T , Owner's Nome ..�`ir• ��`��rrW�� ...0 ./cV .......,City ......... .......................................: <br /> Address . se# . Phone r .....yy <br /> st't' y e <br /> License ............... <br /> Contractor's Name .. . .............................................................�• 1 OTroller CVWt Q <br /> will serve idsrtas© t mercio <br /> ,%° ; } lnsfalfation : <br /> Residence APa ��►�`�)',�,Z'„- �t :• ��i7 -r � <br /> MoMlpgCtthers ..r� ».. o Cinder ....... LotSlxe <br /> .t rarbayr :i <br /> '. Nvrnber of living units'...`. ._... Number of badroon .. .. »....Y» '.-.....r..»» ....:..prtvateL;Y�,>•: ,, <br /> .�.......... ......... t M ti <br /> ,t Water Supply. Public System and name ...............................G Peat© Sa�Y loam Q C*Lo",❑# e: 1 <br /> '"<•' Character of soil to a depth or 3 feet: Sand❑ Silt j] aY : ..l f .... <br /> type»............. «. ..Y <br /> ' t " Hardpan❑ Adobe❑ Fl11 AAaterial.... yeer ' <br /> z ` ' laced:on'rev+rta'tiTdel�p <br /> buildings, etc. must be ? <br /> ?' (Pint plan, showing size of lot, location of system In rstatic� to wells, ng , <br /> itted availayle►ii*..n 300 <br /> ;f blit sewer Is <br /> No se tic tank or seepage pit <br /> perm public <br /> NEW INSTAMATiONr ( P _ 'Liquid.Depth <br /> e a <br /> PACKAGE TREATMENT j ] <br /> SEPTIC TANK,{ . ....('o+�! .... Nc Canportnu nb ' <br /> Material. s_, <br /> Copuciry Type d. �d�.........' <br /> s- Distonce nearest: Well .. ..................Foundattorn 4 OOi.Y , <br /> 4 = f Lines �.._....... length of each hne.....� •••......••••• Total .Lenges +, <br /> NG LINE �f No. o .. S. <br /> 1EAC?I TC .p' Box M!�"-.. Type Fiiter.Materlai .!QR <br /> '.Depth Fifer Material ...� <br /> �a................ Property, <br /> to nearest: Well p.f ........ Foundation 1 <br /> Distance ii N 1 Rock Filled `Ye* No A. <br /> ;. ash Diameter umber ......... .......��. .0' r-.ti+.;•i [l: r; . <br /> SEEPAGE PIT Depth a--.y.. :. <br /> ,. �O' .....Rock Size <br /> �i Water Table Depth ......i prep, Line -. '......._...._..- <br /> �a Well .Foundation .................... <br /> Distance to near <br /> ests i <br /> REPAIR/ADDITION(Prov. Sar.;'-don Permit tit ....................................... <br /> Date ...................»................................:... ..».: •• <br /> Septic Tc.ik (Specify Requirenants) ....................................... .................r...............»....... 1...»i..: <br /> Disposal Field (SpeNfy Requiraments) ................................ ..................... ..........11.......................... ............».._�':{ <br /> ................................ .......................................................... "} <br /> ........... <br /> ...................................... .. .. <br /> .........•••.••.......... that 1 have prepared this application <br /> and that the work will Ise done In accordance with Son Joagain' <br /> v,. Draw existing and required odd;tion on reverse sld*) <br /> 1 herby certify <br /> P <br /> f` County Ordinance!, State Laws, and Rutes and Regulations e} the Sea Joaquin local <br /> Ifralth District.Nestle owner of gcen� <br /> a':': ,:° Its strdt n+aetner. <br /> fi sed agents signature cod the fallowing: wmlt is issued, I shall not esnpley ant►Perms <br /> y "� certify that In the psrfermanu of the work for which this p <br /> Y': as to become subject to Workman' Owner <br /> s Compensation laws of California:' <br /> r �:'• i <br /> Signed ....... rr•:. <br /> ... <br /> ..-.............. ..... ....................... <br /> litle.......................... <br /> _ <br /> ther than owned <br /> vOR DEPARTMENT USE ONLY.__. <br /> DATE `�... ... _.....- <br /> !. PL1�ITION ACCEPTEG SY . . <br /> ............ .................................... <br /> DATE . <br /> ............ <br /> ^i t!7:r.G PERMIT ISSUt . .............................................................. ..... ................................. .. . _ <br /> /,4f "i )NAL COMMENTS ... ..... ..... . <br /> .............. ... ................... .............-............ -......., '.......,.... . ....... .... -�.. � :;7:...:...:.......... <br /> r ...-.. ...j.. - .... . ...... ......... <br /> Date ?. ......... <br /> Finol inspection by: •. <br /> B/7h 3K <br /> EH 13 2h 1--69 &'V. 51 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t ti <br /> 1 <br />