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e � "� <br /> V. <br /> FOIL OFFICE USE, x. <br /> .... .:. ... APPLICATION FOR SANITATION PERMIT <br /> ..... IComlt'big fn lrSpRtat`�? Permit No. <br /> This Permit Expires t Year Freers Data Issued Date issued �'.:��� 7 <br /> Application Is hereby made to the San Joaquin local >fealth District for a permit to construct and Install the,utak It*refn <br /> devrlbad.This 0130catian Is mad* In compliance with County Orrd>inonce No. 549 and existing Rules and Repulatlonss t' <br /> JOB ADDRESS/LOCATION X2.. 1 ll .... .... <br /> ��' ..... CtxJSLIS TRACT ` <br /> Owner's Name . .... - - ............. <br /> Address ..... -.5.._tc�•.:7 .. P}tone ................ <br /> ' :ontractor's Namr.� .. .':�C <br /> e... ._ <br /> .. ._ :. ......................................License ►1.z � ...�. <br /> Pham <br /> Installation will serve, Qer�te Apartment House Cwrimarcial aflar Cour! 0: <br /> MotelQ Other............................ .._...... i <br /> Number'of living units............. Number of bedrooms _ <br /> ....Garbage Grinder <br /> Wot*r Supply, Public System and name .................. ...........-..................�.. Lot Sin .- :._.Private <br /> �. <br /> Character of soll to a depth of 3 feet, Sand E3' Slit© pay 0 Poet 0 r.Sandy Loom[��,day Loans❑ , <br /> Hardpan E3" <br /> Adobe[] Fill Mata►taf......_....Ify <br /> 4�F `a'1Ve - �1'lam......• •.........«• y $ i <br /> plan, showing size of lot, location of stem fj <br /> En relasi n <br /> . s1► o to wells, buildings,d s <br /> , etc. must bo'.Placed aced on <br /> n9 reverse side. . <br /> NEW iNSTA"'nONs ....(No septic tank or seeparge pit permitted if public sower is available within 200 festa <br /> PACKAGE TRE0.TMENT [] SEPTIC TANK[] Size........ .........__--• Depth r <br /> t <br /> Capacity l '4`'���yF� .. aterial_ :............... No. Compartments <br /> 4 <br /> Distance to nearest Well..-__•..............................F <br /> oundatton......---•-........ -.Prop UM'- <br /> CQ! <br /> LEACHING UNE [] No of Lines .. th <br /> ._._.�._.... . tang each line................... ... Tonal ""th ....... .O <br /> 'D' Box ...f'....... Type Filter Material .. Depth Filter Matalal ; <br /> ................ <br /> Distance to neorests Well ...............•:....... Fivaclation ........................ Properly Lin* .... r <br /> T I 1 Depth .................... Diametor ............:... Number .......... Rack Filled Yet <br /> { Water Table Depth ...........................•--...:.....-...,.--Rock S s - fl r`!O � <br /> Distance to nearest,Well ..._,.......... <br /> ..................... ... ...............Prop. Wte 3 <br /> REPAIR/MDf1rM lhw.: Itallor%Permit dk ................................... Date .................... ..... ..j r <br /> t Septic Tank(Specify/Requirements) ...................... ._..... ... _........... ... <br /> r Disposal Fieloi .(Specify Requirements) ��.. r <br /> i ............_.-.•.. _•-••___w••...w_.• .•_•..........._.........................-•w-•.-•.....w..•.................ww..--..•_�._.....w_»-w.r..-u_�..-n•-...... <br /> .•._. <br /> .......................... .................................. <br /> (Draw existing and required addition on reverse side)' ..�". ....w... <br /> r#� <br /> n <br /> b"by t;ertlfy► that 1 have prepared this appllcallan rnd that the work will be don* M atterdarsce wiNs Sens barqWrs " <br /> County Ordinaaces, Slat* Laws,,cwd Rules and Regeslations of the Sar Joaquin Lela! health Distrct.Meme*tuner at lam. <br /> s sed agents signahme aertiffes the following: r4. <br /> "I certify that in th*pefformcnee of the work for which this permit is Issued, I shat! not ample*any <br /> person Its ssstls taattrser <br /> as to b*tam"uhlaet to Workman's Compo satlon laws of California." <br /> ZL <br /> Signed.... / x.. ........................................•Owner : <br /> By.............. .. ............ Title . <br /> (If other thank owned - <br /> D ARTMENT USE ONLY <br /> A APPLICATION ACCEPTED BY >7 <br /> .... DATE .....G .... <br /> _ BUILDING PERMIT ISSUED F <br /> ....................... ................................................I.................DATE—..... ......... ._..................... .- <br /> ADDITIONAL COMMENTS.........I...................•...... ...-•----......._........................................... <br /> h <br /> . ................................. <br /> I.......... ........ ........... <br /> F:nat inspection . .................. /T.e�...f.. <br /> EH33 24 1-68 si4v �{� ...................................................................Data......� ..?.��7 ......... <br /> • SAN AQUIN LOCAL HEALTH DISTRICT a�7 :;. r <br />