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07/0B/2004 10:21 2093613F`9 BAUMBACH 9 PIAZZA-) PAGE 04 <br /> FOR.OFFICE USE: APPUCATION FOR SANITATION PERMIT ilk <br /> • Permit No- ..................... <br /> .......... ........... <br /> (Complete in Triplicate) <br /> ................I....------....... pate Issued _J.. ----...... <br /> This Permit Expires I Year From Date issued <br /> ..................... ....... <br /> n is hereby made to the San Joaquin Local Hea(th,Dlstrict for a permit to construct and install the work herein <br /> Zl"tie,c <br /> or,b,d- This application is made in compliance with County Orclih0rif e VO 549 nd existing Rules and Regulations. <br /> , <br /> ')...-.CENSUS TRACT _- ---------------- <br /> OB ADDRESS/LOCATION <br /> ....Phone .................................... <br /> )wner's Name ---- <br /> ................. .......... ------- <br /> �ddres <br /> ..."City ...... ------------ <br /> ....... ........ ........ ..............-------- <br /> 0 ----------------------------- <br /> _ontr0CtQT'5 Narne ------11.................... ..........License <br /> rtftlintion will serve- Residence E]Apartment House'© Commercial Ora' rQWK <br /> Motel C3 Other.................... ------------ t!!� <br /> ----------- <br /> Number of living units!... Number of bedroom& ---2.....Garbage Grinder Wt.. Lot Size 4-f <br /> water Supply: Public System and name -----_------------------__ ..:...........................................•------... <br /> ... .......Privdiez <br /> Character of soil to a depth of 3 feet, Sand o., SlIto Clay 0 peatD Sandy Loam o Clay Loam 0 <br /> ........... <br /> Giawbardpon)o Adobe E3 fill Material ------------if yes,type............... . <br /> . <br /> 7gs, et, rnust be placed on reverse side.) <br /> (plot plan, showing size, cDf� lot, location of systern .in relation to wells. buildin <br /> (No septic tank or seepage Pit permitted public is available within 200 feetJ <br /> NEIN INSTALLATION: d ifblisewer Liquid Depth �et--------------- - <br /> Size... ...... <br /> PACKAGE TREATMENT [ I SEPTI NK <br /> Compartments No. 00m. <br /> 4�40!�Typ�/ Prop-Aine --------- %Y <br /> Capad <br /> n <br /> Distance ores . Well ..... .. Xv;C........-------Founciefflo <br /> Tool Length Z <br /> .......... <br /> Length of each line./ <br /> LEACHING LINE No. of Lines ----—--- <br /> ............ -----_------ <br /> mcrt6rial / -404CD6pth Filter Material <br /> .......... <br /> D' Box Type Filter property Line <br /> Distance to nearest: Well ....... Foundation Aal .......... <br /> -— ------------ Rock Filled Yer-A <br /> SEEPAGE PIT Depth ........ Diameter • Number ...... <br /> im <br /> Water Table Depth ...... Size .4 <br /> • <br /> Prop. line,_ <br /> . ---- <br /> 04fance to nearest;-Well ..............Foundation .. ---- <br /> REPAIR/AbIDITION{Prev..Sanitation Permit I#'-- ................. -------—...... Date .........------ ...... <br /> Septic Tank (Specify Requirements] _........___1-----------------_--------_------------- ----------------------- <br /> Di.sposal Field l5pecify R equirernentQ •"-------11......... ........_­­............................. ------­­-------- <br /> ....................................................... ---------- <br /> ---------------1------ 11....... .............— •--• ­­,........ i-ri. n o n rev er Ise si de I <br /> (Draw existing and required add c:cordance with Suh Joaquin <br /> y certify that I have. prepared this Opp I litation and that 2he wank will he done in 61 <br /> I hereby Cal Health Distrid, Home owner or liters- <br /> see! <br /> - <br /> Qunty oHipances, State Laws, and Rules and Regulations of Whik Sion J00cluln Lo <br /> sod age-rits signature cettifies the f ollowing: r which this permit jw issued, I shall not employ any Person In such manna'­I certify that in the performance of the work fo <br /> .as to..become subject to Workman's CQMPerk!sol on laws of California <br /> Signed ................. Owner <br /> 7itle <br /> B .. <br /> Y .............. ............ <br /> (if othe an owner) <br /> FOR I)OARIMENT USE ONLY <br /> d'N ACCEPTED BY .... ................. ............ <br /> APPLICATI --------------D ................................. <br /> BLADING 15ERMIT ISSUED ........ ............................................................................. ..­....."...­................-:-__.-'1------------I 1_..._.....'. '.".�'... I <br /> -ADDITIONAL COMMENTS ......................... ------------- .................................................................................... .............................. <br /> -------------- ­­­................ <br /> ............I........ I I....... ...............I...... ........ <br /> ................ ­.... I 1;;1_R1­_­­ <br /> .................. .. ......... <br /> ............... <br /> ............................... .. ..... <br /> Inspection'"...13-Y, ......­.­............ ......I............. ... <br /> Final <br /> SAN JOA,:IUIV LOCAL HEALTH DIST I RICT <br />