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FOR OICT USE' r <br /> FOR OFFICE USE: <br /> APPLICATION MR SANITATION PERMIT <br /> ..............I........ ............... <br /> 11 (Complete In Triplicate) Permit N,.29 <br /> .. ........ .. ....... <br /> Elate <br /> ................. This Psimilt Expires I Year From Do*Issanci <br /> t <br /> Application is4mr;by made to-the San Joaquin Local Health District for a permit to construct and Install the work herein described. <br /> This application isi'made in compliance with County Ordinance No. 549 and existirM Rules and Regulations, <br /> JOB ADDRESS/LOCATION...... 9!LOLA f.Oht..4 <br /> .......CENSUS TRACT-_.._........._............... <br /> Onmer's <br /> r .......­'Phone.................. ................... <br /> ...... ..U.C~. 44t............. 2 7City _ <br /> ........ .........................Zip.•-`............----------- <br /> Contractor's Narniiii........ .... ........... ......................License ........... <br /> I <br /> lnstallat(,&Li.will swop: Residehce 2< Apartment House [3 Commercial 0 Trailer Court [3 <br /> 1 r I Motel 0 Other ­.................................... - ;.: I <br /> Number of living 11 nits j. Number of bodrooms..3... ..Garbage GrindwJ.........Lot'SI=_9A!4?dr_W11F . ............... ......... <br /> Water Supply: Public System and name( welir..... ............................._F'rhiolle <br /> ---------------- <br /> Clay Loom 0 <br /> Character of soil top. depth of 3 feet: Sand 0 Silt C] Clay L-3 Peot ❑ tndy Loom)6 <br /> �z Hardpan 0 1 Adobe E] Fill Material <br /> Ir I if yes, type ................... <br /> (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc. must be placed on reverse sid*.l <br /> NEW INSTALLATION: (No septic sank or seepage pit permitted if public sewer is dvallable within 200 feet,( ~ <br /> FV_T1C:(A�NK )d­_ ..........i....................Li quid Depth......... <br /> PACKAGE TREATMENTk ............ <br /> Capacity....... .............Type................ ......Material---------�S..........;No. Compartments... Ci ..-_-............._...... <br /> Distance to necirest.. Wek.'...... ........... ........_...........Foundation.... ..... . ........ .. Prop. Line.._...._....--.-_........ . <br /> - le \ A <br /> LEACHING LINE ........41 , ...................... <br /> No, of lines ....N_.Length of each line Length ......1A.9. <br /> 'D' Box Filter a_erial-_ <br /> Type Filter Material Depth 4:3 eric ............................................... <br /> Distance to nearest! Welt..._.. .. . ..,Founclation------- Property Line................................ . <br /> No <br /> Sep.1141:01T Depth_ WIP l)iliiipil4.... Nur�ber..A'--- Rock Filled Yes)Q <br /> Water Table Depth....42.._'hm..... ............_...:.........Rock ...... <br /> Distance to nearest: Well......... ..............Prop. Line... <br /> REPAIR/ADDITION (Prev..Sonitaticiiii Permit#....... ...... ...............Date.. .......... ....... .......... 'V <br /> Septic Tank (Specify Requirement III....... ...................... ............ ....................... .......... ..... <br /> . ...................... '..ed,'_........... <br /> >:a.......... <br /> Field (Spiecify Requirements) ......... 11................. ............ -------I...............................A-1—­ <br /> ................ <br /> ...........................A ........................................................ .. ..................................................................................... <br /> ...................................... ................ .................. ............ ........ ........................................ <br /> existing existing and required addition on reverse side) <br /> I hereby certify th,3t I have prepartirdthIs,application and that the work will be done in accordance with Son Joaq?In County <br /> Ordinances, State; Laws, and Rules and.Regulations of the Son Joaquin LocalHtralth District. Home owner or licensed agents <br /> signature certifies tithe following- " i , :� I- I <br /> "I certify that in the performance of the work For which this permit is issued,14holl not employ any person in such manner as <br /> to b#Comsu b rjrMan's Compensation laws of California."to <br /> Wo <br /> t <br /> 00 <br /> *' <br /> to <br /> u <br /> Sign77....�.. ...................... <br /> ...... .................... ..............................................Tide......... ........ —----------------- -----_-_-- ..........By . <br /> ----------- <br /> fif other than owner) <br /> A fjOR DjEPARTMEP#(A*E ONLY j <br /> APPLICATION ACCEPTED BY----...... ----- .............. DATE _ ..71171.. ..... <br /> DIVISION OF LAND NUMBER.. .......�/. ...../........... ............... DATE... j................. .............. <br /> )ITIONAL COMMENTS...................V <br /> ........................................................:17... ............___........ .... ...... .. ..... <br /> ........................................­"'_'.._­....... ............ ............................. ........ <br /> ..............i............ ......................... ......... <br /> —-------------—------- ---------- -- ----------------- <br /> -------------- ......................—........... ........... <br /> Be 13 U SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Final Inspedion b .. ............... <br /> d "'Z24 <br /> ..........I........ <br /> _y!......­.................... <br />