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—OWOFFICE 69Et - N= AppLICA-no FOR SANITAT <br /> , i0N PERMIT .-Permit Noti. . <br /> .......... ...................... 1complete.in Triplicate) <br />...................... <br /> Date issued <br /> ...................................... <br /> yhIs permit Expires I Year From Dots Issued <br /> .............................. ................ <br /> .I I i4ealth District for a permit to c0nstr4d and install the work heroin <br /> Application is hereby made to the S6n Joaquin Loco oy OrdinancayNo. !�49 and existing Rules and Regulations, <br /> described. This application is mode'In compliance with Cour <br /> A .......................... <br /> (250 ZOCZA4 . . ...... . ...CENSUS TR-CT <br /> JOB ADDRESS/) TI N .............. ....c...-... ... <br /> ...phone <br /> ............ <br /> Owner's Name ... . ... ......... ...... .. . ............................................... <br /> b,**D . . . ... . . .—.............. .......................... <br /> ............City"... <br /> Address . ...... * . . ..... ................................... <br /> .... ... ...._.license# Phone ................ <br /> Contractor s Name ..... . ... .... sl.d.encsoApartmeM-14ouse-10-COmmefclOI OTrallor CAUft <br /> installation will serves. -- —18 1.-, 7� 4F <br /> Motel 0 Other ................................... -�, 40 ................. <br /> Number of bedi �2......Garboge Grinder ............ Lot SiZ6 ........X........... <br /> Number of living unift:_1---- N ......._Private 0 <br /> Water Supply; Public System and name ........... ---- ---------.................... <br /> .1 j1- . . t[3 Sandy Loorno ClOYLoam 0 <br /> Character of soil to a depth of 3 feet., -'�' Sand'® Silt 0 Clay 0 Pea <br /> Hardpan 0- Adobe 92r Fill Woterial ............If yes,type............... ............ <br /> Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed On reversewse <br /> side.) <br /> i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Liquid Depth .................... <br /> SEPTIC TANK I I Size........................................... <br /> PACKAGE TREATMENT ..... .............. <br /> No. Compartments <br /> ............. Material...................... <br /> Capacity ..................... Type ------- ......... Prop. Line ...................... <br /> I ...............-Foundation`............... <br /> Distance .to nearest: Well. ............................... . ........ <br /> .... Total Length .................... .. <br /> :,EACHING LINE No. of Lines .................. Lon th of each line............. .................. <br /> V Brix. ............ Type;Filter Material ...............I.....Depth Filter Material,-:........................ <br /> ..................... <br /> I ........ Foundation ........................ Property tine ... <br /> Distance-to-nearest: Well ................ yes 13 No <br /> Rock Filled <br /> ........... Number ............................ <br /> . . ..... <br /> SEEPAGE PIT Depth ...;:........ ...._.`DiameterI <br /> ................................ <br /> :.....Rack Size <br /> W ....... <br /> Foundation .................... Prop. Line ......... <br /> 61stance to nearest:--W011 ........... .......... <br /> .......... D to . ... .. .............. .... <br /> ..... ..... ................ ...... <br /> .............................. <br /> REPAIRADDITION(PrOv. Sanitation PC P <br /> /N - ... . . ....... ...... <br /> .... ...... ...........4 <br /> Septic Tank (Specify Requirements) <br /> .. ................. ........ ... ............. ........••-....._.. <br /> Disoosal Fielci (Specify Requirements) ...........:t................ ......... <br /> ........................... .................I........................ ........... <br /> .......... . .... <br /> . ..............I........................... .............. ................ <br /> ..........I.................................... -- ........... .. . ............ ............. <br /> .. .. ................. ...... <br /> ; i6row existing and required dw ...:............................... <br /> on reverse side) <br /> I hereby coSm or Joaquin <br /> plicaflon and that the wwill be do"tolih Districme In accordancet. Howith <br /> certify that I have prepared this opmo owner Ucern the SonJoaquin Local <br /> County Ordinances, State Laws,:I and Rules and Regulations o <br /> I . �,, <br /> sod agents signature certifies the:following: ermit Is issued, I shall not employ any person in such manner <br /> I certify that In the performance Of the work for which this P <br /> as to becojest to Wo <br /> Oran I ompensation laws Of California:' <br /> ............ Owner <br /> ...... .... . <br /> we a/ <br /> '):9neL4 -- ........ ................................................... <br /> ----- . ... <br /> � � <br /> ....... . ..... . ...... <br /> By ........... ................. ........... <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> DATE ..... ........... <br /> APPLICATION ACCEPTED BY -........... ....................................................................... ............ <br /> DATE,.: ...................- <br /> ISSUED ................................-1.................................... ............. <br /> BUILDINGPERMIT .......1-1...... ..........I....... ...... ......................... <br /> .................... .........I....... <br /> ADDITIONALCOMMENTS - . ......... ........ ............................................ ............ ......... .................. ........... .............. <br /> .... ....... ------ ....................................... .........I...................... ............... ...... .................1--.1...............-. <br /> .............. <br /> ............................. <br /> ........................... ........ .... ............ .... . ........ <br /> .. .......-...... ..........- .......... ....... .......... ........ .Date ... <br /> ................ <br /> ------------------------- ...•--•-......I.....----...... .__..... . ....... <br /> final Inspection by= ............IterHEALTH DISTRICT 8/7h 3M <br /> EH 13 2h 1-69 Rev. 5N SAN JOAQUIN LOCAL HEAL <br />