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.ZP <br /> FOR OFFICMSEt <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ............ <br /> ----------I................--------- ....... (Complete in Triplicate)-'' <br /> ---------................................-------------- Date Issued .T... <br /> _._.-•_-------. This Permit Expires I Year From Date Issued <br /> I or a p construct and install the work herein <br /> Application is hereby made to the San Joaquin!4ocal Hbolth District f permit <br /> c srucr g <br /> described This appli do I ce jth.Co pOrd a nod existing Rules do�..Rlations; <br /> is ma e in cc <br /> 7 <br /> ACT <br /> F.LIATA--- ZACT ......... .. ...I.. <br /> J_aM � SL <br /> Zu CENSUI <br /> 2, <br /> Owner's Name .......... ------ ....... .. ..............._..Phone.52_-�>---*------------------------------------- <br /> Address ..... ........ .......-1 ... -----------------------................ <br /> Contractor's Name---. ------- .. .......---------License# �........ Phone <br /> Installation will serve; Residence 2;--A`pamentHouse,0 Commercial E]Trailer Court 0 <br /> Motel []Other ------------------- ..........--- 1. <br /> Number of living u,nits:...1-.... Number of bedrooms-....Garbage Grinder ff. O--- Lot Size <br /> Water Supply: Public System and name .............. ......................1-1;;;;---------------I.............. ............ Private Er� <br /> Son <br /> Hardpan El Adobe ill Material If yes,type ------------ <br /> c. must be placed on reverse side.) <br /> (Plot plan, showing size of lot, location of system injelatioWNo�wefls, 6u"clengs, e,t <br /> NEW INSTALLATION: (No septic tank or seeps�afir`plt'permittedlif public sewer is available within 200 feet,) <br /> 1�If.-I 99�X 1 .1---- Liquid Depth -15 ............... <br /> I S'Zo- G- L 4� <br /> Capacity-J, _Q.Q_�ypblGlAMateria1. 011�"r.. Nb! <br /> PACKAGE TREATMENT I I SEPTIeT-A <br /> Compartments - <br /> stance t-a nearest: Well <br /> F Proyssu p. Line <br /> ..... oundatio <br /> LEACHING LINE a. of Lines -----2------ _1[_-_,Length,pf�p ---- Total Length <br /> I,,-Alm( liae.t I <br /> 11 /Y " �................... <br /> X- .4jfaj.-6epth Filter Material . .......... ......... <br /> I <br /> 'D-76ox-4 <br /> Distance to n crest ounclation ..... .......-.... Property Line <br /> T Deph 1- ....... 00 <br /> SEEPAGE PI Diameter VNumbe .............. Rock Filled Yes <br /> I Waf.6r Table Dbp,th ..... J .............lock Size ...... <br /> :0 <br /> .-- <br /> Distance to nearest:rest: Well ....... Prop. Line -...... <br /> �0unclation ..14P..!t7 <br /> . ............ <br /> REPAIR/ADDITION(Prev.;Sanitation Perepit#.................... ...... ............... Date .._.._............._.__..____.._.1 <br /> Septic <br /> ................ ------------- <br /> Septic Tank (Specify Req mments) . ------------------------------- ........ ..........-........ ...........I----------------........ <br /> ......... <br /> Disposal Field (Specify ftquiremenA n..........--- ....... ------- . ........... ...... ----------------------------------- --------- ------------------ <br /> ........... -----------------------------------------------...........--.......... <br /> .......... ....... -- <br /> - ---------- .. Q--- �- <br /> ................--------------------- <br /> -------- ------- ------------------- ........ ........... -- ----------- <br /> ....... ...... (Draw existing and required addition on reverse side) <br /> • I hem-by certify that Jih�,@,' repered this application and that the work will be done in accordance with Son Joaquin Joaquin <br /> CountyOr -nanceil Si0te Laws, and Rules and Regulations of the Son Joaquin Local Aeolth District. Home owner or 1.1cen. <br /> sed agents nctura`4;rt�ifiesl the followin'g ,k <br /> - <br /> f the'IL -j <br /> "I Corti In pe dr'�r3 Tthhhis permit is issued, I shall not employ any person in such manner <br /> 4 <br /> I , 4 of California." <br /> as to Is su to en's ens= <br /> attom I W <br /> Signed ... ....... ------ .... Owner <br /> S� ....... Title --- ------- ......... ------ ------ ................. <br /> BY ---------- --------------- ................ ..... <br /> (if other3th.an owner) <br /> --FOR-DEPASTMENT-USE-,0 <br /> .... DATE ..... <br /> APPLICATION ACCEPTED. BY----x ......;........... <br /> BUILDIIVG-PEIMIT'-iSSUE15-.-- - ............... ............... ---------- .............. ...... -------- <br /> ADDITILON,ZL COMMENTS --------- .... .... ->................................. .......... <br /> ...... ------ ............ .......... - ------------------- <br /> ............... ... ------ .. ....... ------- .. . . ....... ................. .............. ...... ---- ----- ----- -- <br /> ---------- ---- - <br /> ................ -Dote --- -------- <br /> ii"n'o-l"l-n--------------- . . ........ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1268 Rev. 5M <br />