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rvx wrri[.c MCI <br /> 4w ' iAPPLICATION FOR SANITATION PERMIT $-- <br /> .......... <br /> .---I (Complete In Triplicates permit No. . .....`S3?- <br /> ................................••............ <br /> r Date Issued . " .7S� <br /> ......---.......................................... This Permit Expires I Year From Date Issued <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulatlonst <br /> ` w <br /> .SOB ADDRESS/I.00ATIOo�llN ..-1�Z3Jl/l� `......1�� ......CENSUS TRACT �.�.5�....... <br /> Owner's Name ...... iffQ 7F. ...... 7^...... ..f.F.?./.'0 ......... . ....................................Phone j ,- :r✓'�._ � -. <br /> Address ...I .r�....T .R. N.KU .......U]! .....-• --......... ty . LI.:Vi - loll ._... <br /> Ad,t! -- _.. ..._... <br /> r7 � ) .. Phone <br /> Contractor's°Name ...... ......`.. '[lP�.. '.....................:... ...............Llcenae . <br /> Installation will serves Residence 01rpoi nt House b Commercial Urailer Court 0 <br /> Motel ❑Other........ .. . .... ........t...... . <br /> Number of livl units:.....! Number of bedrooms Oarbage�Guinder Lot Slze .. <br /> n9 --- -- <br /> .......... <br /> Water Supply Public System and name ""'� j t�� � ._...Private l�S <br /> Character of oil to a depth of 3 feet e Sand Silt❑ Clay 0 VPeat❑ nSandy Loam ❑ Clay Loom gi <br /> He rdpan® AdobeJ0 VIII Mdtdri% ...if es- a ... .......... .......... <br /> ,Plot plan, showing size of lot, location of system in relation to wells t uildings, etc, must be placed on re've'rie side. <br /> NEW INSTALLATION: (No septic tank or seeps It per i ed if public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT { ] EPTIC TAA(K el..s.2�. � ..x�o................. Liquid Depth ... <br /> Copacit .:. ...... Type . ... ......�Mater(a(01MQFVT o Compartments .. : ........... <br /> istance to nearer : Well. 14..;.................Foundation �40 `f':. Prop. Line . .. <br /> TEACHING LINE (4/"No. of Linei ...7:���,_A & 6'f ng " ..each'llne� .............. Total Length .. �?e ....... ` <br /> "D" Box Type Filter". 7IAria! � ..Depth Filter Material ....I ........•.. _° . <br /> - Distance to nearest: Well l . ... ..�........ Foundation ..`Q..�:r..... Property Line .. :.' ..... <br /> .. ....:.. ... <br /> . Rock Filled Yes <br /> SEEPAGE PIT [ Dept D1am tea, ......._.._..... Number . Q� No <br /> (Mater Table Depth�..................`"'� .............................Rock Size ................................ 1% <br /> Distance to ............... Prop. Line .. ......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit 0 .......... ................1�............ Date <br /> l <br /> Septic Tank {Specify Requirements) ............. I ............. ............. ................................ ......_. ....... .........._ <br /> ...... <br /> . .. <br /> Disposal Field (Specify Requiremen#) .............. .......•----... ..................... ................... .. <br /> ..............•-•................_. 1. 11 i II <br /> ----------- ---------------------------------•--•----- •-----. . -- .............. <br /> - - <br /> _.-....... ------. -•--•--- .............................. ....:_:............. .....--- •--.... . ......I....... <br /> ._...._- <br /> {t]rpw existiA_g and required cddltla,6 on"reverse side) <br /> ! hereby certify that t have prepared this app(t[atln andt�t the reotrkialll 6e' dons In aeeordana withan Joaquin <br /> County Ordinances, State Laws, and Rules and Reilulations of she San Joaquin Local Health District. Home ownWor licen• <br /> sed agents sign re certifies the following: . ` <br /> "I certifyt <br /> the rforma 4 he w rk for which this permit Is Issuer[, I shall not employ any parson In such manner <br /> as to becbj t a r an' Co ` sation lows of California." <br /> $igned .. • ... ........ ... ................fl.— Owner <br /> ; <br /> By ..... '° f� itis ..... ,........................................ <br /> (if other than owner) <br /> q <br /> FOR DEPARTME AT USE ONLY � . <br /> APPLICATION ACCEPTED BY ..... -! .- .f................ <br /> - DATE ...... ..`... `. .rte....~ <br /> BUILDING PERMIT ISSUED t �" <br /> _F. ...DATE....-•-....... <br /> •---- _�. <br /> ADDITIONALCOMMENTS ..........4 ........ ......... ... .................................................. .....-..,.----•-..........---.._-...-.......-..... <br /> _....... --. ... ----- <br /> .............................•---•.............................I............................ <br /> .............. ...... ...... ... ......... .......... ---................ ........... ........ .--- <br /> .... .. . .. ..... .. . <br /> Final Inspectio ..... '........ :..........—Date - ....7. ............-...... <br /> Eli 13 2h 1-68 aev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br /> Y <br />