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FOR OFFtCE M ` <br /> APPLICATION FOR SANITATION PERMIT <br /> l ECampltthin Ttlpllcahl Permit Nok cf-4f�" <br /> 1 . <br /> IK. Thb Permit Expires 1 Yew From OMe IssuedDate issued/0 /,9-CJ' <br /> Appl.cation is hereby mode to the Son load .in local Health D-0"ct for a permit to construct and install the work herein <br /> described. This application is made in compliance w4h County CJrd�norce Uo, Sag and existing Rules and Reg u ions- <br /> JOB ADDRES AOCATION V a371.�i•I.la HJ j�w.rtE�• <br /> ��rCOlc';T/kiL=TN`Fj�NSl15 TRAgpCIT��.�.t..O�..y. ..�..., <br /> Owner's Name InvALT,E.�¢ ��%✓yil 'Phor,4 "T41flf. nsR7!'! •• <br /> Address JO3#71 E1�.�0 H yp./`�� � City 1&4AT749 <br /> t Contractors Nome . ..%/TIC ;i1't':X License AIJX.Z.3.110 phonit�.t. ��Qsr <br /> ° i <br /> Installation WAI serve, Residence WpartmentHouse CQmmer[ial j ITro°IorCourt <br /> ' Motel t.]Other <br /> Number of living units: Number of bedrooms Garbage Grinder WZA Lot Size cx?O AdrW4-r • .. <br /> Wo•e• Supply. Pubri[System and name ._....... . .. . . ..... ....... Private 04-11 <br /> , <br /> Chororter of sod ro o depth of 3 feet Sand 9?'-'S;ir 0 CEay ❑ Pam 0 Sanely Loam F Cloy Loam f" <br /> Hardpan 0 Adoho 0 Fill A46nrial Ak. . it yes, type <br /> ° (PIe1 plan, sh*w^g We of lot, location of system �n reluilan to wells, bvildings, eta. newt be placed on reverse side.) <br /> NEW WSTALLAT": , INo septic rani at seepage pit permitted it public tower is available within 200 feet,) \ <br /> PACKAGE TREATMENT [ 3 SEPTIC TANK( [ ,SEW Liquid Depth <br /> [opoc;ly Type Material No. Caimpartmenis <br /> i Distance to nWreAr Well ............ . . Foundation . Prop line <br /> LEACHING LINE [ I No of Linn :........._ of each line, Total Length <br /> tengMt en0 <br /> Y <br /> D' Box).._. Type Filter Matstlot ". Depth,Filter Material _........__ . <br /> Distancen <br /> tosernkWell ., Foundation s�.. Prop" Lyse , _....... <br /> SEEPAGE PIT Depth Diameter Numbe- Rode Filed Y" 0 No Q <br /> Water Table Depth ........ '. ..Rock Site ._................ <br /> Distance to neorestt Wel Foundation ......... .......... Prop., Lyes .... ...........------- <br /> REPAIR/ADDITION IPrev. Sonitation Permits . Dote _.. ,....,...,.,.,.,_I t <br /> Septic Tonk (Specify egV.reR 1 r \ <br /> mrnit) .... .. .._... <br /> 04SPosnl field 1,Sp4Krfy Requitrementsl �1 0. Y,. Al..ew'niC,ae.�.l.- /A��. . i�'.F.s' vT_. d, <br /> sysTt.+T . i <br /> 1 hereby r floe# I haw t <br /> IDraw,existing and required add.tion on reverse side <br /> y erlih prepared IAh eppWeatlea and that the work will be dens In aesordenn with San Jsailrht, <br /> County Ordinances, Sate Laws,'and Roles and Regulations of the Son Joaquin Local Health District. Hems owner or licen- <br /> sed agents signature certifies the fohowinp: <br /> i "I certify that in Me perfermerlce of the work for which this permit is Issued, I sholl net empley a" person in swch nsanner <br /> oi to become subject to Werkman s Comp miction lows of Colifernle." <br /> Paned 1 Owner <br /> By . . 7nM�++ ...•✓ '^ �X /✓ <br /> If Ortier lbryn . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By s.�.Q DATE <br /> BUILDING PERMIT ISSUED l _ .DATE .. .. _... . <br /> ADDITIONAL COMMENTS .. .� _... <br /> i <br /> Final Inspect; .... ... v Dob <br /> SAN JOAQUIN LOCAL HEAITH DISTRICT <br /> E.111 9 1-'66 Rev. SM <br />