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FOR ' '^^ USE. - ' APPLICATION FOR SANITATION PERMIT <br /> �� <br /> - cJ � P ` .x,u./�=.,^..^- ` <br /> ' '- (Complete UnT�pQmwt� ermit No <br /> - �-- ��-- "` ~ � �� |youod <br /> This Permit Expires I Year From Date Issued <br /> 6 install the v,�r� herein <br /> | h �o �6oDon Joaquin Loco/ Health District for o it to construct and n m ena <br /> ~'r '`~''`'' '~ ~~-' ----described. This application is made it !h County OrdinanceNo. 549 and existing Rules nd Regulations: <br /> /CENSUS TRACT <br /> A8d,ess ------ ��° City ..--------------.-.-----.----.---. � <br /> [ontnzctu,'sNomo ------ -----------------~�./�,� ----`--------------------------------License # ----------------- -- Phone --------------------_------ <br /> Installation will <br /> -_--'-'---'|nmoUoUonvWU serve.. Residence E-K�"rtnortHuuso,E] Commercial : Trailer Court <br /> Motel [] Other -------.---------' <br /> Nwnnbe, of living' units <br /> nky- .�� - - - bedroom _'Go,bo�A�a �Grinder <br /> �-'-*^d�.- kmS|ze ^ .��--~^-' <br /> _-'—' <br /> ^v�\�1��Water Supply. Public System and name --- '-'-_.-_-�---__---_'_---'-_--_—_Pdvohe E <br /> Chon�r � s�| � o �� �3f� S�� �|� Clay Peat E] Sandy Clay �m � <br /> Hardpan Adobe�°~�UMotn,� ------------ |fyo� �pw ---------------------------- <br /> (Plot <br /> ------.-_ <br /> (�ct plan, showing size of lot, location of system in relation x» ve |� buildings, etc. must be placed on reverse side.) <br /> NEW (No septic tank o, seepage pit permitted if public xove, is available within 200 feet) <br /> PACKAGE TREATMENT Size- -------------------- --- Liquid Depth -!f----.--' <br /> type'? "aAoh*ria|-- u Compartments -Z------ <br /> D| nearest. Well -.--_---Foundation _^� -' ---. P Uw <br /> LEACHING LINE [ ] No. of tines -----�� ----- Length of each line----ZS..—.--- Total ------------- <br /> 'D' <br /> - <br /> '~ 'D' Box <br /> Type Filter Material -'Dno+h Filter Material �---'_--'-/ <br /> _---'--' <br /> Dimono: to nearest:. Vm.| Foundation 10------ - Property Line _----'.....SEEPAGEP1T <br /> [ ] Depth .��J~...���� �L=.----- Rock Filled Yes [B~' No 0"-., <br /> Water Table Depth -`- `,-=��.-------------' --------Rock Size -------------------------------- <br /> Distance <br /> -------.-.-- <br /> Dimnncn «z'neoreut Well ------------------~~-----------------Foundation ---.---' Prop. Line -------------- <br /> Doh» -------------------------- <br /> Septic <br /> ] ' <br /> (Prev. Sonhn�onPernn�v� _---'-----_--. --._------'--' <br /> � ` <br /> 3ep�cTonk �pecfyRequimmon�) -.---.--------.---'--------_--'--'--,---'��-'_-'-----'- <br /> D|op000| Field (Specify Requirements) ----------- <br /> -'''-'__--'-----__'-'�-�--_---,-_.—'—__--_—.—.---.-'---- --------'-_-----' <br /> - _-.--'-_-���---'-----_---- <br /> ---_—._.----�~----.—.__—._—_—.__.—. -----�� <br /> (Draw existing and required addition on reverse okdn <br /> U hereby certify that y have prepared this application and that the work will be done in aw«ordmm*w with Son Joaquin <br /> Cowmh/ Ordinances, SMxxm laws, and Rules and Regulations oVthe Som Joaquin lmmml Health District. Home owner orlicen- <br /> sed mgentss[gnmtvmpmwrtifieothe following: /~& . <br /> "| certify that in the performance of.t16 work for »mh|mh this permit is issued, U shall not employ any person in such manner <br /> as to become subje to m laws of California." <br /> 6igne6 �-.-8w��-x.-- <br /> ----------------------------------------- Owner <br /> By -'------- ----------------------------------------------- �--------------------------------------- Title ------ ------------------------' <br /> ° (|fothorthon owner) , <br /> u FOR DEPARTMENT USE ONLY <br /> --- <br /> ---- <br /> --������r ^"�`. " .'',|'` <br /> Date � <br /> ---------- <br /> Final Inspection- -_--- -..-___-_-_~\'�. 2AN JOAQUUN LOCAL HEALTH DISTRICT ----------- <br /> E. <br /> - <br /> E. H. 9 l''68 Rev. 5M <br /> � <br />