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lu 'a <br /> No.. <br /> FOR OFFICE USE: • APPLICATION ll SANITAT10ji'll 'Ill Permit <br /> ..... .. .... .I................... (d <br /> .............I...— 1 1. (Complooln TrIpticote) Date issued <br /> ................... ............. Issued This Permit Expires 1 Y\ear Rrorn Date I <br /> the work herein <br /> ... install <br /> .............I.......... .............. <br /> Lin Joaquin Local Health District farAermit to construct <br /> 549 and existinOules and Regulations: <br /> hereby mode to the 5 N. <br /> Application is adi!in compliance with County Ordinance .1 a. <br /> described.This application is m NSUS 'TRACT --------------•---------- <br /> JOB ADDRESS/LOCATION <br /> .. .............Ph <br /> s Nam :--0. <br /> II ----------- <br /> mkj F? - ---------- Ci phone ---- ................. <br /> Address !cerise# il uff. <br /> - ------------ <br /> Contractor's Name .... Re Apartment lsidence t House 0 Commercial OTrcliler Court <br /> Installation will serve: <br /> I .................. <br /> Motel [3 Other Size 7Tf7=.. <br /> I Garbage Grinder Lot <br /> mbor of bedrooms --- %..........Private <br /> Number of living units:..-r. .. Nu .....--IN <br /> I ..........--............ ------ <br /> Water Supply;Public System and name -------------------------- Clay [3 peat C] Sandy l.00miD Clcly�.Loamol—, <br /> Character ofsilt00djpthof3fee1t-. Sal <br /> Silt ---------- <br /> 0 fill Material ........ ---if yes, type ...------------ <br /> Hardpan [X Adobe 0 <br /> placed on reverse side.) <br /> — 'Wings, etc. must be <br /> lotion to wells, ou, <br /> (plot plan, showing size of lot, is available within 200 feet&�., is <br /> 1 ation of system in re d if blic sewer v V <br /> c tank or seepage pit permitte Pith ........ ----------- <br /> NEW INITAL!:�TION-- I I a septi, ............ Liquid Del <br /> Stzenx."X /.V <br /> PACKAGE TREATMENT SEPTIC TANK* al............ <br /> lsg-a......... Type Material No, Compartments <br /> lCopocIty JP -.. <br /> ......Jim .....IA-.......I Prop. Line ..... <br /> Foundation - <br /> �J-44 V Distance Ito nearest; Well .—Length of each ::..Dept...Ill 41............ Total Length ...... <br /> f• 'No. of Lines ..—A---------- ............. ......... <br /> LEACHING LINE 14 1 .... ' -=--�& ... h Filter Material ... <br /> a Filter Material <br /> V Box'.-. ... i <br /> - Type I J& ........... property Line. <br /> DistanceitA nearest: Well —JAM.- Foundation - Yes 93 No <br /> .2 ..............g6ck Fill-ad <br /> Diameter ...... Number -------- <br /> GE PIT [4 `Depth ------ <br /> SEEPA ................-....Rock Size --------- --------------------- <br /> Water Table Depth .'--------------- Prop. Line -------------- <br /> S ..........Foundation -------------------- <br /> 'Distancii!to nearest:Well ...... <br /> Date ..... <br /> .................. <br /> ion Permit .............................--.—..... <br /> REPAIR/_ A_ (PrevJ Sonitai ............. <br /> �ptic Tank�� pacify Requirements) ......... --------------- -------------------------------- .............. .............. <br /> Dispo 1 Sol Field (Specify. Requirements) .................................. ...... ....................................................................... <br /> ................. .......................... .................. ............... ..........-............ <br /> 1A ............ ......... ------------------- ................ <br /> ..............--.... <br /> I id required ociaSa^Ju <br /> reverte st a. .... I [Drow exist ng at in OccOrdance with San Jouscluln <br /> irepared this application and that thowill done Istrict Home owner or licen- <br /> Y6 -H*01* 0 - II herele certify that I have F oquin li�eallI s and Rules and Regulations Of 'be � <br /> county Ordinances, State Laws, . I . — - I Nany person in such manner ::3 <br /> certifies following: d I shall not ORIP10Y <br /> sed agents signature I&of,the work far which this pormit,lis issue <br /> 111 certify,that in the performance�,s Compensation laws of Californil <br /> as to become subject to Worland <br /> Own <br /> Title 3. ............. <br /> Signed -I --- --- 7— <br /> BY if other th&n ownerl <br /> DEPARTMENT USE ONLY <br /> DATE ---------------- <br /> ------------------1.......... E ........................-----...._r.. <br /> ... ......--------------------------- <br /> APPLICATION ACCEPTED By '%-Z ....... .....DAT <br /> BUILDING PERMIT ISSUED.....-::t------------------------------------- ......... ........................... <br /> ADDITIONAL COMMENTS —-------- --------- ................. ---------------- ...... ---- ---------- <br /> ................. ............... --------- .... ............... .... .... <br /> .......... ...... ..........—1...... <br /> ........................... ...... .. ....... <br /> -------------- .............---------- ---------- ........ 'r--------- <br /> -- -------- ............. ......-....— <br /> ............. <br /> ................ .......... <br /> .............. <br /> Final <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1-'68 Rev. SM' <br />