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,F43k OFFICE USE: _ 1 <br /> APPLICATION FOR SANITATIOU4ERM1T <br /> ........- � .......................... <br /> (Cmplefe in Triplicate) Permit No. ..7....... <br /> 7 .Aho......... <br /> ...................................... <br /> ........................... This Permit Expires 1 Year From Onto 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 mode in compliance with County Ordinance No. 544 and existing Rules and Regulations. <br /> IOB ADDRESS/LOCATI ��� / d 'PFT� `. / ¢-......CENSUS TRACT ................... ...... <br /> Owner's Name b� '`,,t.„7/p/t jp� p-7 <br /> . . , <br /> ................ .....Ph One <br /> Address CityR . .. <br /> .................... ..... <br /> .F.S/.. <br /> :.......... <br /> Contractor s Name t� =F liC�wtlG'G°�Y � /CLIl.d4aicensa # .Z/.9.?/..Z?Phon& wS �� la/•.7( <br /> t « i •a <br /> Inatoilmion wtll nerve, ".', r� -Residonib rA�ibxriment House[] Commercial❑Troller Court. Q t <br /> Mire[{] dthe <br /> Number of >)�ng uplt3l! I •.. Nu <br /> hm eYspf edrooma. .. o-, <br /> �:..Garbogo Grinder ..�.. Lot Size ...../.[....r?,L�rj......: <br /> Water Supply: PO Iiq&Systsin and nbtne' 4! ......,f c r va <br /> i <br /> _r j•� <br /> Character of sol*to.d dbpfh of 3 feet yard Silt❑ Clay ❑ Peat 0 Sandy Loam 0 Clay Loam Q <br /> a hardpan❑' Ad'obe ❑ Fill Material ...........:if yes type +' <br /> (Plof'plcn;'showing size of lot, {ocatioq jo;System -in relation to wells, buildings, etc. must be placed on reverse:.side.[ <br /> NEW INSTALLATIONrJ INo septic tonk19i;see0age'pit permitted if public sewer is available within 200 feet, / <br /> PACKAGE,TREATMENT [ ] SEPf1CTA11C; �- Size...../ 8�... . ��Z —� <br /> _ . J�......... Liquid Depth ................. ........ O <br /> Capacity .l�aZ1,'?Type .&W.VPMaterial4%Ale o. Compartments ..... •••••••. OQ <br /> i `� <br /> �,. <br /> Distance.;to,-nearest: Well ,..�L ..•.. *.Foundotion :... D...�•..... Prop. Line .....�I�:........ <br /> LEACHING LINE [ ),, No. of Lines .?..:.:zr.-...:---. Length -of each line.........`7P.�........ Total Length fi/i ?I <br /> ti `�,� g q��,� . .-- .�.. <br /> -'a D' .Boz":..::..;Type Filter Material .. ;tf....Depth Filter' Material .. ,l.Q.........�...' <br /> Distahce 7o nearests Well .-. l�oG././,��oundotion ......`..O'? D:.� <br /> / k J............. Properly Line ..... ... ..- .•.•. <br /> SEEPAGE PIT f <br /> [ ] Depth ....:..;<,'::..-':.- Diameter •........:...:.. Number ............ .....:......... Rock Filled Yea ❑ No Q <br /> Wat€r,Table Depth ....................... ..Rock Size •.......... ........... <br /> L <br /> Diafance.to narest: Well.....:.:....:.....:.............::...•:Fnundotion ..c.............:. Prop.=Lino ...:....::.::...•..K:1_ <br /> 4, . <br /> tEPAIR/ADDITION(Pr`:Sanit ation'Reymi151s ..• .......................... Date .................................. <br /> ) <br /> r'• M ! • ,. <br /> Septic lank (Specify Recjui einentsl :r::..:.:.........._..•: .......... ......................_..._................t......... 6 <br /> Disposal Field (Specify,Regyrlterzlerlis r........................................................... <br /> ...........•....................................•............ ......... <br /> .:...:........... .......... ....... _............... .................. ........ <br /> il•. <br /> _.................... ............:.....>:..........:...:................................:......._............ 1 ,. <br /> _-• <br /> .(Diaw* and required addition an reverse side) ' of <br /> w <br /> hereby certify that 1 haveph <br /> . ropared this application and that the;'work, be donsi in accordance with ian Joaquin <br /> :euny Ordinances, State Laws;,and,hulas'and Regulations of the San Joaquin Lout Health District. Home owner or`liceo- <br /> ed agents signature cerftfies the following: '� 1 <br /> '1 certify that in the performaiics-af'-tha.,work for which this permit Islisued, i shall not employ any person In such manner <br /> Is to become subject td,Workman's Corllpe'nsallon laws of California." _ <br /> 1 nod ...............::..� ! „ . Ownerr <br /> y ....... w� _....... ...•...... Title .. <br /> ' .. ..................... ..................---.._............. <br /> 11 ther iiia: own , ••----�- <br /> i <br /> tA.t. ,•. Shk DEPARTMENT USE ONLY L <br /> kPPLICATION.:a 4-* PTEDP 4 .. ...: _.•.... ......... _............ <br /> - DATE .......* ..7. <br /> UILDING .PE MIT.ISSUE. s.' ` `ir....._^.'.._... :........•... ........_......:... .......... .............DAT <br /> q E ..................... .........:.......•. <br /> ADDITIONAL b(1N1ENT51:.:z.".l<...•.•. :3...... ....................... _ <br /> •'•y- ........... ....•....•............... .. ..... ....... <br /> InOI ITIS�eCt10IT.b i .y., .. _,.'� ..,. Y ..... ...................................•.........•......-. <br /> .......... .................................................. <br /> ... ..... ...i........ <br /> ..P' .-.•.•_ '".. ....... r. ........••................................ .....Dote ... ...... .._ ..-:?..'...i........ <br /> SAN 16AQUIN LOCAL HEALTH DISTRICT <br /> H.13241.6g'Rv,t .as y w. f 7i11au <br />