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.:....- FOR <br /> .....­­FO I R-OF- .FICE-USE:-- -------------- APPLICATION FOR SANITATIO14 PERMIT <br /> .. ..................................... ey <br /> ) <br /> Permit No. I.S- <br /> IoT4!1[PTrIplicaiieU., Dote Issued <br /> ------------------------------------------------ <br /> ---- --------- ­­ This Permit Expires 1 Year From Date Issued <br /> ,I <br /> Application is hereby made to the San Joaquin Local Health District for a.,pI <br /> ermit tS".construct and install the work herein <br /> described. This application is made in compliance with County Ordinance!'Now. 540--drid existing es ndttegulations: <br /> it I- �q Rlu I" 1p <br /> JOB ADDRESS/LOCATI N <br /> _13627--w-S -------CEN SUS TRACT <br /> Owner's Name ------- ...... ..................m.......Phone ----------....................W-W....... -------- <br /> Address .... .......MI-m .. <br /> Contractor's Name w40WA(__.0AC$j4VF—------SERV....[!'icense# ......... ------I.... Phone ................... <br /> Fi <br /> Installation will serve: %'Residence JWApartment House{] Commercial J:]Trail&Court 0 <br /> 1� .... <br /> Motel F1 Other-- ----- .......-...... <br /> Number of living unitsAAV4�mber�of bedrooms 3......Garba-0%rincler Lot Size ACA.Sarme........ <br /> TrIame ..............­­.......1.7 ....... ......M.........W...___ e__� <br /> Water Supply: Public System and :m� .... .Private <br /> Character of soil to a depth of 3 fiiett Sand 0 Silt F Peat Sanay •Loam [I <br /> :3 Clay I )l -Clay Loam W� <br /> Hardpan Adobe F-1 Flit 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 seeps pit permift6d,if public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT [ )' SiA�-i ---------- <br /> SEPT' X.5 7---------wwww... Liquid Depth ....77d. <br /> Capacity I Compartments.2 -Ab Material aWCft_F No. Com <br /> 49.40 � Type PREA \y <br /> ,ii.,l)-kance to nearest: Well ... ----Foundation __Alp Prop. Line-s... C <br /> AIR Ij I <br /> LEACHING LINE NcL of Lines ----- Total Length ._...j M.......... <br /> I: <br /> 'D ----------- <br /> Box IF�S. Type Filtet%Mote 49C&bepth Filter Material ...)47 lee .........110......... <br /> 0 L4-- Property Line <br /> Digance to nearest: Well 30"clati n ------ <br /> SEEPAGE PIT Depth .-.j. ._.--- <br /> (..... Diam ry-X-8e.. Number ------------- - --- Rock filled Yes 9?' No G i <br /> woie-r.-T-WDepth .--....----Rock Size <br /> if <br /> d a <br /> .. .....L#4940.. -........Foun ati Prop. Line <br /> Distpece tothecrest: We ......- <br /> -- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date ........ ------ --------- <br /> .......... <br /> Septic Tank (Sp4d01Re4uM6ments) __------ ...... ...... .............. <br /> ------------- <br /> Disposal Field (Specify Requirements) ---- ------------- ---------W.............. ------.........-......................... ........ <br /> OT �..Zfj Tki d'i 0 f <br /> ----------- - -- ---- ........W................ ........... <br /> ................ ........... --­­------- -------I------------------------------- <br /> ------------------- -- -W........ .............. ...... .....................]:� <br /> {Draw existing.and redluired addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be d6no j.i" accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen. <br /> sod agents signature certifies the following: <br /> "I cern at In o njante of the work for which this permit is issued, I shall not employ any person in such manner <br /> c' Vilib='s Componsatizin laws of California." <br /> S, -----_-------- --------_-_-_------ Owner <br /> . <br /> By----------------------- --------- ----------­_................ R-k ... litle ......__------------- <br /> ......... ------------------------------ <br /> (If other than owner) <br /> FOR .DEPAIRTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ........... ...................................... ...... DATE ----- ------- <br /> BUILDINGPERMIT ISSUED ..................................... ....................................... ...I.-DATE --------_---- -------_-------- --------- <br /> ADDIJJONAL COMMENTS- `---------------------------------- - ------- ........ .......... <br /> ............................................... <br /> ----------- <br /> ... ......... ...... -------- <br /> :7. ..... <br /> .ate.. -------=,f .... ...... ..............------- <br /> Final lnspect7io;;:;i� ....... ......... .......Date-.._.._ .... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1.'68 Rev. 5M <br />