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FOR OFFICE USE APPLICATION FOR SAWATION PERIM / <br /> • "' permit No. <br /> (Get%pte» <br /> In Triplicere) <br /> This►trash E:pRos 7 Year Rete DoH Issued Dote Issued <br /> Application is hereby made to the Son Joaquin Local Health District for o permi• to construct and install the work herein <br /> deszr�bed This application is mode in compflorsce with County Ortdiinonce No. Sig and psis-'r•g Rvies and Reguintions <br /> JOB ADDRESS,AOCA��TIyyON ,Ss,,�e JP.'2"*J if Y1/w. �j .�:!/. I�� CENSl15 TRACT S y 7 <br /> Owner's Norco /i./,rcA"U -.. /fi!r",tr..r ... . ...... . . . .... /Phone <br /> Address OP /p IT-.4 �.. '�/ A. City <br /> Coe.tractat%Name ir.-.n.+� . .. .. lKerrse N Phone <br /> installaton will serve. Residence,&Aparfrnent house f-1 Commercial 01taiier Court ;'; <br /> Motel 0 Othoir � <br /> Number of hv.nq unity: Number of bedroom* .. .Garboge Grinder Lot Size t v—&--*`.r.. . .. . .. <br /> Wolof Supply Public System and name ..... . .s .. . .. . Priva/e� <br /> Character of soil to a depth of 3 feet. Sond o Sib d Cloy K7 Poor7j Sandy Loan © Coy Loom D s <br /> Hordpan[j� Adobe L' Fill Matonal If yes,type . .. . <br /> IPiet p'on. showing size of lar, location of system In relation to wells, buildings, etc, must be placed an reverse side.) <br /> NEW MTALLATHM INo septic tmek or seepage pit permitted if public sewe+ is available within 200 feet,) <br /> PACKAGE TREATM[Nq ; J SEPTIC TANK Sixe. r q Oepth d <br /> fy1 9 t1�ti► ..SLi vid <br /> Capacity b-A /'s' Type,'1'A1!Wt!V 1Aaseriol !'.,rrfrbe u ti Na. Campartmants 1E-. ..-._.. . .. 11 <br /> D'stance •o newest- Well .lA-f7Tlr Favndation /d Prop. Line ,r <br /> LEACH:NG LONE ( J No of Lines IL Length of beach line /.!I'D Total Length A+.11' ........ �f <br /> D' Box &,,4C Av" ype Filter Mareriai P Depth Filter Material /.p - <br /> Distance 10 nearest Well Foundation property line •.><..... 'Y, <br /> SEEPAGE PIT i Depth A S- Diame'tei, Numbe• �- y Rods Filled Yes No Q <br /> Water Table Depth ..I.ar' Q .� ..Rock Size At <br /> Di stanee to nearest; Well A'I' FoundaCcin f.C"D prop. time �4 <br /> REPAIR/ADDRIOPI IPrev. Sanitation Permit♦ Date ) <br /> Septsc Tank (Spec•fy Raqu•rernertrsl - <br /> D,sposof Field lSpecify Requirements) - <br /> (Draw ex vng and required addition on reverse side) <br /> I hereby cWtify that 1 have prepared this application and that the work wHI be del in attendance with San Joaquin <br /> County Ordinance%, State Laws, and Rules and Regulations of the San Joaquin Laval Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that In 1140 porformonco of the werlr for,whish No pene:t is issued. I shell not employ any porton in svrh motto r <br /> as to become blest to WOIIKP ser i ComPenwtlan laws of CONferule." <br /> S'grn J i*ou�tsi[J � Owner <br /> By Tilte <br /> (if orher than ownerl <br /> MR DEpARTMRIT USE ONLY <br /> APPLICATION ACCEPTED BY i! t DATE <br /> BUILDING PERMIT ISSUED DATE - <br /> ADOiTIONAL COAthkENTS <br /> Final Inspecsian by: � � .. . Dal -70 . <br /> SAN JOAOUiN LOCAL HEALTH DISTRICT <br /> E ". 9 1•'69 Rev. SM <br />