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FOR OFFICE USE <br /> APPLICA7`lee: FOR SANITATION PERMIT J 96-6 b J <br /> l (Complete in Triplicate) Pipern it No. . . .,. <br /> Data Issued ..S. �..... <br /> ` .... ._. ..... ..._._._. ThhPermit Expires TYear FremDeft lassfedt <br /> plication is hereby made to the Son Joaquin local Health District for a permit to construct and install " work herein <br /> scribed;:his application is made in compliance with County//Ordinance No. 519 andel stisting Rules and Regulations, <br /> CENSUS TRACT . <br /> B ADDRESS/LOCATI �� J• C- ... ' �7 c , <br /> vner's Name i? o�r� y: .....Phone <br />:drew �C��y 7„�J ! X.G..Clty _ o..( <br /> ntractor's Noma ......__.. .G?�tTtl..,'1Gd. 4....�..`. . ... ..d'•c,llanse I ..... .... . ....... . Phone ... <br />.tallmlon will serve: Residence( rtment Houses]Commercial QTrailer Court O <br /> Motel OtMr.... ...... .................... <br /> rmber of livingunits,.. .. �...... .....-... ...................................... <br /> �..... Number of bedrooms ....� Garbage Grinder .. . let Site .... <br /> ater Supply, Public System and name .................... ..................................._.................. ..............................Private 8� <br /> aracter of soil to a depth of 3 feel, Sand 0 Silt E3 Clay Q Peat Q Sandy Loam ❑ Clay loom 0 Q <br /> Hardpan❑ Adobe(Fill Mebrlol ............If yes,type......................... . <br />''of plan, showing site of tat, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br />:let OWALLATIONt (No septic tank or see Ige pit permitted If public sewer is available within 2C I feet,) 1 <br />.CKAGE TREATMENT I I SEPTIC TANK(/ She j / �i/ ." .. . Liquid Depth �l.. <br /> Capadty .Jk;7c+..... Type Material.....de)cC:... Na CompaitmenM .. ,a........... <br /> 1 Distance to nearest: Well / --fC.. .................Founc'Llotion.. ../D............ Prop. line., ............... <br />%CHING LINE <A No. of lines 3 . . length of each line ... ..7C..... . . . Total length ...,........ <br /> 'D' Sox ._../ Type Filter Material ... ��.!�.......Depth Filter Material .._19." \ <br /> Distance to nearest: Well Foundation /4r Property lite . ....... <br /> EPAGE PIT (41 Depth .. .. Diameter --AWe//- Number .......... Rede Fllld Yes 0--'No <br /> i <br /> Water Table Depth ... _ ....................Rock Sia ...�li?... r�.3...... <br /> Distance to nearest, Well _. . ./CL/OF,,.._..........F..Wm ......l..c..fl Prop. Un* ...sem...... <br /> R/ADDMON(Prov. Sanitation Permit t► . .. . ... .. Dab ..................................1 <br /> Tank (Specify Requirements) _... __....................... <br /> . . <br /> ...... ..... <br /> sol Field I(SpecifyRequtremenfsl . .. .. ...._. _............... ........_................ ............... . ..... . <br /> ....................... <br /> ............ ..... .. ... <br /> .. .......... ... .... .............................. <br /> (Draw existing and req. :red addition on reverse side) <br /> l;y certify that I have this <br /> cation and that " urnirk wM be dome In accordance with Son <br /> ► Ordinances. State Laws, and Itulesaandl Regulations of the SanJoaquin LOW health D sl Mct."once owner er lie <br /> r1 <br /> 1t signature certifies the following: on in such manna ter which Isis permit Is Issued,1 shallnMemPthat in the performance of the work 1Marty pmome subject to Workman's CompenOwsation laws of Califsmfa <br /> . w <br /> ner <br /> 1 Ci i� � Ctc /« <br /> ./h+� •� � `lc/ ,a. Title . <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY _ <br /> r - DATE <br /> 'PtICATiON ACCEPTED BY � ' 15°O � DATE <br /> '4DING PERMIT ISSUED <br /> )DITIOAIAL COMMENTS <br /> ' onto <br /> or,l inslwctson by •9/711 ► 3n' <br /> 1 1J 2h 1-68 W-v. 5tS �,irt 1�/• D�iJ tCXnl. HEALTH DISTRICT <br />