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FOR OFFICE USE: r <br /> ...�--------=--=-_ ...._ <br /> AP CATION FOR SANITATION PERMr) " <br /> (CoretpleteinTriplicate) Permit No. <br /> -----••---- -••--•-•---------------- <br /> . <br /> _•..............:...•.---•---......._.__..... This?"Mit Expires I YearFrent 00110 Issued Date Issued <br /> 4pplicotion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> k."bed. This application Is made in compliance with County Ordinance No. 3.49 and existing Rules and Regulations. <br /> aB ADDRESSAOCATi " _.._/.5rq.9 d_ � ,�� �� <br /> ?wner�s Name --- - CMA TRACT ......... .......--------- <br /> - -- .. .. .............. ... ...Phone ...................... . <br /> ddressri� r� <br /> ;01*04tor's Name ..... _ ..........Ic _.. _--. ------------License # ltltone ......:.....:.............. <br /> utallotion will serve: Residence[J Apartment House❑ Commercial❑Traller Court 0 <br /> Motel❑Other...-•....................................... <br /> lumber of living units•__.1 Number of bedroomsGarbage Grinder <br /> --- - •---•.. ..... Lot Size . i4...- ----. <br /> later Supply. Public System and name ----------------------.....-___-_---- <br /> -- - <br /> ... . ...: .. ._..................................................Private ❑ <br /> haracter of soil to a depth of 3.feet: Sand❑. Silt❑ day ❑ Peat❑ Sandy Loom❑ Clay Loam Gj_— <br /> Hardpan❑ Adobe fl Fill h1laterial ............if yes type............... ............ <br /> 'lot plan, showing site of 'lot, location of system in relation to wells, buildings, etc. must be placed an reverse sldet.# <br /> EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within!200 f_eet,! <br /> 4CKAGE TREATMENT [ } SEPTIC TANK{ <br /> � Capacity Type -------------------- Material~. --------- --•-•--1`4Q. �4Cmnpahempthenft-----.._.�.............� <br /> Distance.to nearest: Well ------._----__ -__ -----_--- _..Foundation ......................Prop. Line-........._........... � <br /> ACHING UNE [ j No. of Lines ......--- •---- 0 <br /> Length of each line: ----- Total Length ........... ................ <br /> 'D' Box ............ Type filter Material .................Depth .Filter Material <br /> -----....---•.......... ........... rn <br /> Distance to nearest, Well ........................ Foundation --- Property <br /> 1PAGE PIT ( 1 Depth ------_----•-•---. Diameter _...._.......:_ Number- - --•--- Rock Filled Yes ❑ No Cj' <br /> Water Table Depth ---------------------_-------- ..._..Roc k Size .- -----•---•--• -------------- O• <br /> Distance to nearest: Well ---------------------------------------;Foundation <br /> ---•.............." Prop. Una ....-......._.._......OQ <br /> AiItJADDIT1oN(Prev. Sanitation Permit ......................... Date --..------•..__- <br /> pc7 <br /> :Septic Tank (Specify Requirements)..__...._.. <br /> -- - - -- -------- - --- - <br /> -.�......------- <br /> Disposal Feld (specify Requirements( -- - �-z-,c' - �L�,,-- �„r ,.,�• .. __ - <br /> ____ <br /> ---- <br /> �• ._ .y.. ____________________------------_-------------..........-----------,.........-------_...-------------------- <br /> (Draw existing and required addition on reverse side) <br /> mweby certify that i have prepared this application and that the we& will be dens in accerdgrrce with.San jowlstn <br /> romp Ordinances, State Laws, and Renes and Regulations of the San Joaquin local HOW&District. Home owner or licom- <br /> fogents signature cedifies the followipW <br /> that in the performance of the wo* for which this permit is issued. I sham not employ any person in such mannan <br /> #o beeetrne subject to Worknean's Compensation laws of California." <br /> - ------ ------------------ Owner <br /> ---------------- ------- ------ -------------- title -•- - <br /> ------------- <br /> (If other than owner! . , <br /> R DEPARTMENT USE ONLY <br /> 'PLICATION.ACCEPTED BY------ ------ - <br /> ....... •---•--•---••..... : .............. _- -, DATE - .• :- = <br /> IWING PERMIT ISSUED --•-•----------•- '- - _ <br /> ---••--------------------••---------._--------- - DATE.. - <br /> ►DITIONAL COMMENTS --------------=•--- 4----- - --.-- • . ' <br /> -•--•-------------- ---------------------­------- =------------------------•-:,•.--------_...._.-. <br /> ::------- -------•-•--------------.... �.... :. <br /> -- -----•--•-----•---- ------- ----- <br /> ai Ins ion b - <br /> i Y <br /> .._---Date---. ......� <br /> 13.2 1-68 ileo. 5H JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M / <br />