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FOR OFFICE USE:' <br /> APPLICATION FOR SANITATION PERMIT 3 <br /> ---------------------------------------------------------- (Complete in Triplicate) Permit No: -71:7---- -------- <br /> ------------------------------ ---------- •----------- Date Issued <br /> This Permit Expires I Year From Date Issued <br /> ------------------------------- -- ---------- 160-3 0 <br /> Application is hereby made to the Sdn Joaquin Local Health District fdrAa­permit-,Jo construct and insta I the work herein <br /> described. This application -,,s made in compliance with County Orcli{once No.,549-and existing Rules and Regulations: <br /> A F-SCnLON76jM WFN-fV1 -----CENSUS TRACT --- <br /> JOB ADDRESS/1-01 ATI Q.-},TQ------ -----------;.;---------- <br /> 93 73-�2- <br /> L-----6� t-----Phone <br /> Owner's Name ------ h--P E- -4-46TEI�� <br /> Address ------ Rox 4 LO <br /> :5-7,T--------------------------------------------- City _-------- } <br /> Name 477F.RD-Ur" N-" <br /> ----5i�-RqACELicense # -------- -- _- --Phone 5-Z-7------ <br /> Installation willAEtrye. Residence F1',Apartment Housef] C6mmercialTrailer Court <br /> MoteM l ❑ Oth a <br /> r L----F BKICAM- PtF}r\ <br /> L <br /> Number of bedrooms ------------Garbage�Grinclerj ---- Lot Size ------------ <br /> Number of living units:- <br /> f�W-V- - P r i v a t e XIVVA mp", I <br /> -M&Aaa-&uppl�y- Public System and n <br /> . Clay Loam,11 ('0 X <br /> Character of soil to a depth of 3 feet: Sando Silt[I Clay 0 ' Pact I] Sandy Locirn <br /> kA <br /> Hardpan F-1 Adobe-F-1 Fill Material If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.,) <br /> NEW INSTALLATION: {No septic tank or serepage...pit-permitted if public sewer is available within 200 feet,) <br /> Liquid Depth -------------- <br /> -------------------- <br /> PACKAGE TREATMENT SEPTIC TANK 1 4-2— <br /> Capacity Material CM-M97TE-No., Compartments ---------------------- <br /> Distance to nearest. Well /Vio, ----------------Foundation- / ---------- Prop. Line --------- <br /> engt of each line---- <br /> LEACHING LINE ------ ------ ----60OTotal Length <br /> X No. of Line ------7 0� <br /> Box/--jcT-;�i- Type Filter Material pja.Cf-v----Depth Filter 4 Material ----/9-1----------------------- ----- <br /> -11-------- Property Line <br /> Distance to nearest. Well -- -- <br /> - -- Foundation 10 -7---- <br /> SEEPAGE PIT Depth .......1V------- Diameter ---------------- -Number ------- -----------------I--- Rock Filled Yes E] No 0 <br /> Water Table Depth --- -------Rock Size -------------- ----------------- <br /> ------------------------------ a <br /> Distance to nearest. Well ----------------------------------------Foundation -.-----:------------ Prop. Lin ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation7Vermit# -----------------------------------t-------- Date --------------------i--------- -I <br /> Septic Tank (Specify Requirements) J--------------------- --------------------------------------------------------------------------------------­------------------- <br /> 4 P11-H, -i W�?gr-- 0WE--- ---16--- <br /> Disposal Field (Specify Requirements) :T47CIK-----VARt �w <br /> -t J-4 7 Djr--------- ---- ---------- <br /> R7 ---- ---B V---I-------------- ----- --- <br /> 6-C <br /> 7 R <br /> EN-C- --------F ---157------------- ---------- <br /> I - . ---- A <br /> ----- ---------L3 -11,i5w-----4%1(-----A -­67A/x---µ--- ------------------------------ <br /> (Draw existing and required addition on.reverse side) <br /> I hereby certify that I have prepared this application and tkqt­.t9e.work will be. done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of they San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: person in such manner <br /> "I certify/that in the p rf manceof the work for which this permit is issued, I shall not employ any <br /> a to be me to orkman's Compensation laws of California." <br /> s Owner <br /> ----------------- <br /> Signed --- ------------ ---- - - ----- ----- ----- ---- <br /> BY -ukbxv 7K-------sfpwt 'Title ...... ---------- -------- ---------------------------- --------------- <br /> (If, 0thVr than owner) <br /> FOR)DEPARTMENT USEr-PNM,-) <br /> TE <br /> ......6 <br /> APPLIC-XT-'I6N- ACCEPTED--BY-m�!-�4 J.a , - ­­­ ­i��---------- <br /> :V mF ------------ ------------------------------- --------------------- <br /> ----------- <br /> BUILDING,,PERMIT-!ISSUED; DATE------------------­­-.--,---.a­=-4x;- - <br /> J_ZJ---- ------------ - - - & ------------------ <br /> -COMMENTS-.- 9- 15 --------- <br /> ADDITIONAL <br /> 0 -0 -------------------------------------------- <br /> Disp-[Tz-:�---------iARIA <br /> u->------ <br /> J-71 - - -------------------------------- ----------------- ----------------------- <br /> - - ----------------------- ------- ----------------------------- <br /> ----------------------------------- -------- - -- --------------------- <br /> - ----- --------------Date <br /> Final Insp n by- ------ --- ---! �� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />