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FOR OFFICE USE APPLICATION FOR SANITATMN PERMIT <br /> Permit No. <br /> lComplaN In Triplicate) <br /> _....... ......... <br /> Thls Po sell Expires 1 Year grew Deft(sated Deteissued ]Y- <br /> Application is hereby mode to the Son.10a"In Local Health oistrin for o permit to construct and Install the work herein <br /> described. This application is mode M twmpllenoe will+ C0Ur'tY Ordinance NO. 549 and existing Rules and Regulations, I <br /> JI}E ADDRE f%OCPON �P 7,2I .CENSUS TRACT <br /> Address `s 'RL i�/S ``<.+s rt , t ahr�. Y/ Phone <br /> �„t City <br /> owner's Nome may) / ar <br /> Consrodor s Nei Pr 71 ts.t !.1. ecce-. ' tiansi♦ /!7.3e`,Phone <br /> Instonut►on win ante+ Residence Apaanent House 0 C"merciGI F7r0'ler Court D <br /> t Math O Other, <br /> `t <br /> Number of living units, r Nvmber of bodrosrns .......Garbage Grinder Lot Size <br /> Wow Supply, Public System and name .._ . u <br /> Character of soil to a depth of 3 feet; Sand 0 Sdt 0' Clay d: Pear D Sandy Loom D Clay Loan D <br /> fferdpo n D Adobe D Fin Material if yet.type <br /> (Plot pion, showing size of la, kxation of system In natation to wells. bvilclings, etc. must be placed on revWW side.) IN <br /> tRfp INSTALLAUMs (No souse tank at seepape pit permitted if public sewN is available w:1hirs 2(A feet,) � <br /> PACKAGE TREAT/AINT I I SEPTIC TANK I ] Sim'. _ . _. _ Liquid DeptL+ V <br /> Capacity Type Matotiol. . .._ ..__._ He. Campmlments ... ..... <br /> Distance to neG�ess: Well FotttldMian Isr". Line...................... <br /> LEACHING LINE f ] No. of IJnet Length of oath life. .._ . . Total tNgMs . .......................... '-%/, <br /> ' Ty pe F hor Mamio: _ <br /> - ... ._..DOP011 Filter Material . ......,....... ........... <br /> __..._..__.. <br /> M0111100M0111100to neatest: WallFoundation,. _ _ -__Property One ........................ <br /> SEEPAGE PLT I I Depth Diorneter _ NUrnben' . .. ._. Rack Filled Yes d' No Q <br /> water Table Depth ..Rock Size <br /> Di tar"to neaten Won .. .. -. :... .,.__ ....... . .....FouiidaHon Drop. Lies -......_._........... <br /> WAIRJADOITiON(Ptev. Sanitotie t Permit <br /> Septa Tank (S"0y Its"ItemeeMtl . ... -.fir►- ... _ <br /> o.tposor Field ISpecify Repu1nrr-1-1 <br /> (prow exist,ng and tegvired addition on reverse side) <br /> 1 hereby cenify that t have ProPerel this opplicallen aid that she work will be Iona Mn ectordente with Son Joeauin <br /> tevnry Ordinances, Stole Laws, and Reties sod RegsrlaHens of the San Joaquin Local Health Diskw- Mane ewnw er tire► <br /> sod agents signature testifies the following: <br /> "I certify that in the performaate of the work For which Oki* permit H Issued, IT shelf eN employ airy Parsee In such ieenner <br /> as to became subject to n's Compensation lows of Colffotsda." <br /> 5gned ., �i q <br /> .. .. ...... ..... Owner <br /> 6y l� yr/ ��S!L lisleowner) y <br /> ,;s POR DEPARTMENT USE mal , <br /> APPUCATION ACCFPTFD 9Y ,. .. .... ...._.._..__..... <br /> CTU:LDING PERMIT ISSUED DATE <br /> ADDITIONAL COMMENTS I <br /> F nal �nsf>e+�.c. .. Dasa '9_4V_'7.2_ <br /> SAN JOAQUIN 'OCAt HEALTH DISTRICT Ali <br /> E P 9 ?- 68 Rev. 5th <br />