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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT <br /> permit NO. ...��.5 � 4� <br /> ICemplete in Tripli caMl <br /> ... isstred /".,. . .. <br /> rs <br /> This Permtrlxpees 1 Year Foe.a DaM Issued Daps <br /> Appl4calcon is hereby made to rhe Son Joaquin Local Health Distrin fp a permit to construct Ord install dee work herein <br /> desrlbod. This application is made in�COOmPllorxe with Coouujn�tyy Ord,nonce No 549 and existing Rules and Regulations:. <br /> JCM ADDWSS/LOCATI ���7' /�( CENSUS TRACT <br /> Owner's Noma <br /> Address <br /> Licen <br /> Contractor's Noma �f_-, ComrneKialM rolM1r fenlrt Pfser+a10 <br /> Installation will serum Ras denw L,i4o;; Wm House❑. ❑f 0 <br /> Metes©Other ' ..__ ... II <br /> Number of living units: Number of bedrooms J .,.Garbage Geindar Let Lzza <br /> Water Supply,. Public and name t ... .. . Private <br /> PP Y= Nan! 1..._ .....,.., .. _ ._ - -. <br /> Character of soil too depth of S loot Sor d& tr`❑ CLOY ❑ IP0 7 _VoFkY Loan ❑ 'tlay Loam f; <br /> Hardpan❑ Adobe(,] Flil M61orial.'.. If yea.type .. - 1 <br /> JPlet pian, Showing slza of let, teriatian'of system in relation to walls, btAldings, tic, must be placed on reverse iII&I I1L <br /> NNW NISTALLATIGM: IN*septic lama a seepage Pit permMfad it pubik sower is avollab !e withiri 700 feet,! <br /> PACKAGE TREATMENT SEPTIC TANK( { Siva __ �. Liquid Depth <br /> Capacity Type F1Cller`3a1 s No. Compartments �. <br /> r, ?$sane to_nearasr Well <br /> '�_Fpvndotian Prop- Line _ . 00 <br /> { to Ips of each line _ � Total Length _ ... Jul <br /> LEACHING LINE { No. of Heels _. ng <br /> D' box Type HI»r Material Depth Filter Material 1 <br /> L <br /> Distance to nearest!l Well Foundation Property lino i <br /> ., <br /> SEEPAGE PIT 1 <br /> Depth t �D4amotar, s` ^Numbs 'NRoek Fiilod' Yrs ❑ No Q <br /> Waver Table Depth..: ` .. 1 . Rock Size <br /> Dlstonee to rw~t weft Faxddtion _ . Prop. Lina ............ <br /> RIPAIR/AF70fl10N(Prw. Sanitation Permit/ . _ ...-.. Dara ._. .. ...... ' <br /> Septic Tank [Specify Requirermenesl <br /> Disposal Field tSpecrfy Requir.mamea <br /> Meow ex;stin9 and required addo;on on revmse side) <br /> I hereby certify that i have prepared this applieatil" wtd that the work WWI be done to accordance with Son JanTaln <br /> County Ordinances, Steps Laws, and Rules and Regufadota of the San Joaquin local Hoch% District. Hama owner or Remo- <br /> 1 sed agents sigrietuee certifies the following: <br /> "1 certify that in�lrte performance of *0 week for which tows permit Is issued, 1 stroll mar employ eery person in sons+ <br /> h mo <br /> as to becamelect to Werkman'a /mjpilmotiion lows of California." <br /> r Sigreia 1 .(���.t jre:Y�"� owner <br /> 1 <br /> By .. ..__. .._. . . Jiriw <br /> Ill edict than Owned <br /> OTM DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . / � DATE <br /> BUILDING PERMIT ISSUED _ DATE <br /> ADDITIONAL COMMENTS <br /> Flrgf IrtspaeHan Lty+ <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1-V Rw. SM 4 ; <br />