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FOR OFFICE USE: APPLICATI <br /> ON FOR SAN#TATION PERMIT <br /> ................ .......:..: ........... ........:.. (Complete in Triplicate# Permit Na <br /> •" ........................................ This Permit Rxpires ! Year Ecom Doti issuedI Date Issued <br /> A <br /> lkco tic n is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work:herein <br /> desciibed. This application Is mods In compliance with County Or mance No' 549 and existing Rules and Regulations= <br /> I / <br /> i JO ADDRESS/t~4CAT N <br /> P Owner's Name r'�,,.,.� .� . ... tom_ CENSUS TRACTT C <br /> Address . a'..r.�^ ..... _...,.... .........PI10Qe .�i.l _-1.�f.1/J�. <br /> ! /J� ..,city ,��( ? <br /> Cor►tractor'rt Name ...... .......... � -;.......License # ............ .......... ....... <br /> Installation will serve: itesidesce ApaOmani Hou sa fl Commercial E3Tralfer Court ] .... . s� . '. <br /> Number of Elvin .Motel 13 Other...:;. <br /> g unttar,. : ..-.. N+►enber of bedrooms . ..7Gad"e-,&I tder .......:.... Let Slee. <br /> Water Supply: Public System and name . �- ..... <br /> . <br /> Character of tall to a depth.of 3 feet: .,Sand .............................. <br /> ...+. ...» <br /> r <br /> Slit 13 day ,d Peat(' Soewly Loam 13 Clay Lacim <br /> Hardpan 0 Adak@ Fill ..............`._. P+ 'f . .: <br /> :. <br /> N " <br /> 1PIot plan, showing else of lot,'location of system In relatlon t* wells,rbuildbtgs, etc. ewsrt be... <br /> NOW INSTALLATION: ie�f.� +ever�re side. <br /> (Na septic tank or seepage.p1t K pub#k sewer Is a�raila6le within RQp feet.l <br /> PACKAGE TRIITMENT ,,.-SEPTIC NK <br /> •..... :. ...... <br /> LA <br /> x- Capacity .................... Type • ... -� <br /> Distance ....... Conn ............... ..» 6 <br /> Oce to nearest: welt .............................fundatibr�................. ...., Pii+op. °Q <br /> LEACHING Lli�il;`� ` No. of Lines :..: . ..... Length of cath ........��� <br /> ......... ' .... .. Tetai Latptli . <br /> -:T-ype filter Material .Depth FtltorJliAalgriol .~ .. <br /> IDistance - �. ... . .......................................... <br /> ce to nearest;'1lVell .... .........'Fouhdation props Llt�e G <br /> SEEPAGE PIT <br /> i } rhl .... ...... :,oa <br /> _. <br /> Dep aiarneter♦ -.... Number .. ....:�:: Rock :filled Yes.(] •( <br /> Water Table Depth ............................ IV. <br /> Raft 5i:e <br /> .. <br /> Distance to nee <br /> . rest: Well � <br /> RkPA1R/i461DlTtO .... .Foundation .. .. .......... Prop. Lim . ° <br /> N(Priv. Sanitation Permit ........... • ... ..» <br /> ....., Date <br /> Septic Tank (Specify Requirements}... .,? ...... . ... �..... <br /> aI Field]#Specify Require <br /> snit w ..� .•�.. .... <br /> qj. .. ................. .... <br /> he' (Draw existlrequired addition an reverse side.......................... ............................................[ reby certify that ! have prepared this application and that the work will be_dot�e. in +accerdattca witlf ,leOqu� 4 ; <br /> County Ordinances, State laws, and Rules and Regulations of the-San Joaquin Local Hea#th,Lifstrid.Naasolner gt Via• <br /> sedagents signature certiftes'the followl6g: <br /> "[ certify that in the performance of the'work for hlch shit•peratit.[s lssveed, I shag not oinploy air person � sttdr <br /> mensw <br /> as to become sv ect an's Ca pentad la7 f Califprnia." <br /> Signed .._ <br /> - Owner . <br /> By -. <br /> -- . - �_,, K title <br /> ;. (If other than owned ~~ t <br /> FOR!DEPARTMENT�U&l ONLY <br /> APPLICATION ACCEPTED BY ... ... _ <br /> BUILDING PERMIT ISSUED ........... .." .. __".j`__..'r �' -- •-- DATE <br /> t - € <br /> • <br /> ADDITIONAL COMMENTS ..--- ---....--•--•-•---"............. °• " •---------...,.._..----,_... <br /> ..............DATE .....----".. <br /> ___________________________________________________ _a - .._.- ------- <br /> ---­------------------- -" _... • ........-............... ..... <br /> Final Inspection by: ............... - <br /> •-• --- -----.Date . <br /> EH 13 2!i 1=6$ Rev. <br /> SAN JOAQUIN AL HEALTFJ DISTRICT 8/7h 3M ,# <br />