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FOR OFFICE USF: <br /> .........:1...I....j- APPLICATION FOR SANITATION PERMIT <br /> .................................. <br /> (Comphitis in Tepucate) pwmitNo. .A1-.AZq <br /> ............... i 'I <br /> . ........................................................ T i Permit Expires I roar From Best Issued Dale Is" <br /> Applications Is hereby made to <br /> described the Son Joaquin Local Health District for a permit to construct and Install the work heralis <br /> This application is made in compliance with County Ordinance No. SA9 and oxl.�tfig Rules and Reigulationst <br /> JOB ADDREss/incArION ...... ....CENSW TRACT .......................... <br /> Owner's Nome <br /> 4 ......... .............. .... .............. ......phone 981,,. ss. ........ <br /> Address 5(t.57, 5 <br /> vP4"1Q3.j...... .. ...... ...............city ... .. . . ..... ........ ........... ...................... <br /> FOR 0 <br /> ... ... .. <br /> . . ...... <br /> E, ......... . . ...... <br /> Contractor's Nome ..Anz .......b.ACA040.9.!..................................License # <br /> Installation Will serve, Residence[]Apartment House 0 Commercial JQTraller Court 0 Phone (a <br /> Motel0 Other............................. ...... ....... <br /> ii <br /> Number of living vnits:....L...... Number of bedrooms ...........GLrbage GKncler .... ....... Lot Size ............................................ <br /> Water Supp!y: Public Systss�. and name .................................................... ......................................................Private 0 <br /> Character of toll to a dep sof <br /> of3feet,, SandE] SlIto Clay Pact- Sandy Loom r_1 Clay Loam 0 <br /> Hardpan 0 Adobq 0 '°Ill Mistorial............ if yes,oype............... ............ <br /> (Plot plan, sho—Ing size lot, [motion ef systern in relation to wells, buildings, oft. must be placed on reverse $I&.I' <br /> N"INSTALATICiN: CX <br /> I 'Optic tCnk or seepage pit permitted If public sewer is available witi-.1n 200 feet,) <br /> PACKAGE TREATMENT SEPTICTANKf I <br /> Size...............:77777=�i.................... Liquid Depth ................ ....... <br /> CC city 16t-.0,9.... Type 9 fAncr-ta:nearest: Comportmorsh ....... <br /> Well ............. Prop. <br /> .............. <br /> LEACHING LINE No. of Lincs -Z.. ............. Length of each line....Z+57./............. Total Length .......................... <br /> r V Box .... ..... Type FilterMaterial ....................Depth Filter Material .......................................... <br /> I . <br /> Distance te'neamst; Well ........................ Foundation ........................ Proosirty Line ...................... . <br /> SEEPAGE PIT Depth ..... . . ........ I .. .Diameter ................ Number . . ... .............. Rock Filled Yes 0 No <br /> ... <br /> Water Table Depth ....................................Rock Size -.............................. <br /> Distance to nearest: Well ....... ...........................Foundation .................... Prop. Line ............... <br /> RIPAIR/ADDITION(Prev. Sanitation Permitill ..... . .............. . .......... Date .................................. <br /> SepticTank (Specify.Requirements) ................ ...... ......... ....................... ..................................... ..... ..I............................. <br /> Disposal Field (Specify Requirements) a.......gy,1.5.3 z j�L ......V)E.R.Tac-... ........................... <br /> ......11-3).1.3.�1.atv <br /> & ....:.................. ......ma)K <br /> 3 13 N Ll..O.jrJ .M ......... . -.40 <br /> .......... <br /> . .. .. .. .......................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Son J"qwb <br /> County Ordinances, Stott Laws, and Rules and Regulations of the Son Joaquin Iticell Health DIStrict. HOMO OW7W Of 11;86 <br /> sod agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is Issued, I shelf not employ any person In such manna <br /> as to beryl <br /> e r 'e Lit cirkman's Corpen Clio" laws of California." <br /> I ��jjlo <br /> Signed, --A.......... ... .......... Owner <br /> By ..........-.... ............ Title <br /> III other than owned <br /> FOR DEPARTMENT USE ONLY <br /> -77 S ZVA\J.r- DATE 76.......... <br /> APPLICATION ACCEPTED BY R . ...... ....... <br /> BUILDING PERMIT ISSUED .... ...... DATE ........... ....... ......... <br /> ADDITIONAL COMMENTS ..... ....... ....... ....... <br /> ...... ......... <br /> 4 ........ <br /> / ate <br /> Finot InFisecliotl* by; 5�v . I . D ' —,7c—'7 ........ <br /> Ef 13 2L 1-611 Rev. 5M SAN JOAQUI14 LOCAAtALTP DISTRICT 8/74 3M <br />