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APPL►CN(ION ICOR SANITATION PERMIT <br /> lCompitte In Triplicate) Permit No. 7/..."A..�!. <br /> This Permit Expires 1 Yeas from Dote Issued Date Issued f`�w:;7 y <br /> Application Is hereby made to the Son Joaquin local Heahh District for a permit to construct and Install the work herein <br /> described. This application Is mode In compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESSAOCATiON ....G../ ........... <br /> Owner's Norco ..... ..l!� ._ ............................. <br /> CENSUS TRACT .......................... <br /> or nq <br /> ...... <br /> ;•' t! .... •................._r ........ Phone �f ..:�,, .�1.......... <br /> Address ................ . <br /> ,a - a ,t1 Cid' .... <br /> Controctor'e Name............ •"f `. p'> ......................ilcense . alaT�.........».. <br /> Inetollotion will sorvor P Resldenoe 1porlmenl House Q Commercial❑Trotter Court O . <br /> �► Motel C3 Other. <br /> Number of living units,... 1�..`'A4wm of bedrooms .... .. Q..�s•�-r . <br /> Waller Ga►bogs Grinder lot Size <br /> Supply, Public System and no ..................................._. J�,r 0 <br /> Character of}all to a depth of 3 feet: Sand .... ..�...........................................:. Private OL <br /> ❑ Silt❑ Clay ❑ Peat❑ Sandy loam 0 Clw loam ❑ <br /> Pon❑ Adobe Fill Motorial ; <br /> t <br /> ............If yes,type <br /> ............................ <br /> E <br /> Wo pian, showing else r of system in relation to wells, buildings, etc, must be placed on rem-se side.) <br /> NW INSTALLATIONr (No septic tank see <br /> -�+.-■---�..�.« ` l�W Pk permitted If ��p'b'fc sewer I�oYpilable within 200-feet,) <br /> /IYCIcI►GE TRtATM�1T ( SEPTIC(TANKt ze.... d.. X.f�d� ..�...."'}..L. liquid <br /> Depth ....�I}.•• « 4 <br /> �1 . Type �:1G�YJ........ Materbl...!,�?ffi.... No. Compartments . .:�.,,,..« <br /> Distance1&6wish Well ...........s .J..O.�....:..... Prop. .7�f '�. <br /> LEACHING LINE JQ of ..... .�............ �....... line . ..... <br /> • Length of line. .�. .. Total length ..F,�'.. <br /> • Type Filter Length <br /> .!s».O:f�i.......Dept;r Flltw Material! ..... ..........» <br /> Dls to rtes Well . , <br /> i ..._... Foundation ......��....Y...... Property Lim .,... f' <br /> SEEPT j Depth .'.�r. ...�.» Number ..........1..... . ».... <br /> WoI�} ....f Rock Filled Yes No ❑ <br /> De ................................. .Rock Nze <br /> Distance ft neoresh e ...... -t.« .......Foundation�y.�.i.....Y.r�..;.1.�.. �P» <br /> ro..p. <br /> . Line <br /> REPAIIVAADDITION(Prey,Sten <br /> Septic 'i ark ( � �-_ - 11t#'..»..........». ...............». Dote •) <br /> spgdf► .......................... ..»..........»................».»»;........ .................. <br /> Disposstl Field (Specify Requlir .....»«.. . ..f.. '�-•• _ ... _..»«... « <br /> ............ ...»..............�. ...-?� 7f, <br /> ......:I................._... �„............................................................................................. ... S <br /> ' �(Oexisting and i squired addition on <br /> heroby. ...�y.......�� •• � reverse sldoj................................................... .. d <br /> tertlfy ►ha4l( PP ' <br /> ProPand t s application and that tine work will be done in accordance with Son J p ) <br /> County Ordlnanco�,,flote Laws, and Rules and Regulations of the Sap Joaquin Local/Health District. Home ewner w II & <br /> sed agents signatuhs tertifies the fQllewing1 >..1 <br /> "I certify that in tht performance of the work for which this permit Is Issued, shall'net on, to an <br /> as to become subject to Workmon's Corot .. P Y Y Peron In wch on <br /> pesss0i*n'`Jaws of California.- <br /> Signed <br /> Signed ... .......:i. ......... ....... : �`' y. Owner <br /> By.......... ..... <br /> (If on owner .y ....... <br /> .... ....._........ 71t1e ..'»// �• <br /> ' ther L .r ." '`Z..................................................... <br /> itOR DEPARTMINT USE ONLY <br /> APPLICATION ACCEPTED BY �.1 ..?...��............ ». <br /> BUILDING PERMIT ISSUED ».......�.... _..»........»....................r..................... DATE <br /> DDl <br /> AITIONAL COMMENTS.............._...._.........�.;....... . <br /> ........ .........................DATE ....................._............. ... <br /> »....».._»..........»._.........................:.....ti_.•...�....».................»........................................................... » <br /> ..................._...... ... ..:................................ .T <br /> Final Inspectbn`.by.. »�......«. ....... ............................. ... .. .. ............................:..........:... <br /> 11 M Cjtt It/ :..,,La...�l. ..«....»............................ .... ......Date <br /> v SAN <br /> AQUI HEALTH DISTRICT <br /> QC <br /> E H. S 1,'68 Rev.5M <br /> 7/ <br /> + s <br />