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"s- <br /> I <br /> sI /"-'-FOR OFFICE USE: � - Cde//�r/t>,rif 76- 94,VZA) FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> a-_-_--_-----tJ -' Komplete in Triplicate) Permit No,......-----------_. <br /> f^ I Issued..sr3"J� <br /> This Permit Expires 1 Year From Osie Date Issued <br /> i <br /> Application is hereby made to the Safi'`.�epgoin_Qk:bl<t+iiiplth 15W. 4 tdErr a permit to construct and install the work herein described. <br /> r This application is made in compliance With County Ordinance.549 bnd existing Rules and Regulations: _I <br /> - _ _ . _ . _ _ <br /> JOB ADDRESS/L . TION_fS...�nr.--__.S. .�./.� .-- -- <br /> !, I C ilSUS TRACY.S <br /> ------------ <br /> i -O{G•ner's Nome_--4!?tr.. <br /> .....�.t.SlR�ty - ' -' " ..�Phone- .. <br /> _ r <br /> Ada/v <br /> ;�r... <br /> 'rens.....:..:_.....�..:...................:...... !/ - - - - <br /> ............ ......................city----------------------------------------------Zi -............. <br /> .._. <br /> Contractor's Name-:. . -----t_tcense*jW1WYF_•Phone <br /> 1�allation will serve: Residence, Apartment douse0 Commercial ❑ Trailer Couf- <br /> / r"- . motel � Oth r:.:.....:....:............ .....:....:.._.._ <br /> Number of.living units:.,1.._i... Number of�~rboms._S__...Garbage Griaider.- .Lot SizE..,; <br /> Water Supply: Public System. <br /> and.,name..................:..-- ...,��.:- 'Y�/� - i.., d/ <br /> --- '-••' ------•-_...-...-•--_........ ) <br /> 4� racter of soil to a depth of 3 feet: Sand Silt❑ flay❑ Pedtfl Sandy loam Q Gay Loam [], <br /> to <br /> ./ Hurdpdti❑ Adobe Fill <br /> (Plot plan, showing.arze of lot, location of system in relation to wells, buildings,ate l ust be placed on reverse side.) <br /> NEW INSTALLATION: (NJ seo is tank or seepage pit p!rmitted.if public sewer is avfii)pble within 200 feet,} <br /> PACKAGE TREATMENT { j f SEPTIC TANK j;7 iS e.. _.._: a.• - [Liquid <br /> Capacity / <br /> { � �% -- - Depth.\-------—- - . <br /> ,/��--'---��Pe�- '-7+'faterial' _ ..No. GOm arimenh--.. ..�•. ------- <br /> Distance to nearest:Well.:..._IS�---._i-.... . Foundation.: D ....Prop. Line_ -• -- <br /> /rLiE.e -_P -------------J <br /> Length f ecr' lire 1. .. .:.....:...;..._. .._Total Le�th.: <br /> ). B . <br /> -'-----TypdfiNer Materiaj7Glx... epth Filter Material., j- ..._...._ .-,_..._.......lp <br /> -.. _ <br /> Distance to nearest: WeII y1��J7�r _f/?Fo(mdo, n `_--.Prop;rty <br /> t <br /> �rsPiT f 1 Depilt-------- ----Diameter--------+ --- --- m - ---------- --- � , Rock-Fillerd�es Nocd <br /> .. .... ..a .. _. . <br /> Water Table Depth-�....-:.__--• ----•_-. _. Rock Size:------_L- -• ---------- I V 1 9 <br /> r ,7 ? <br /> Distance''tonearestt. 'I . . .. 3� un_dation_'_.:``.G._� .....PraP- Lina.-•-.- ........_t '� <br /> k <br /> REPAIR/ADDITION (Prev. Sanitation Permit#---------it.............. ------ <br /> r <br /> _ ? -a:.__.::._► <br /> Septic Tank (Specify Requirements).---'-... .._...::_..:: ._.. ,h.----:. .x:-----'--....�.:.__:..b:_;t---'---._...-•--,}--'----...::-.-......_. i <br /> f ': } <br /> !" - s <br /> Disposal Field (Specify Requirements)-......_._�"s..........:.. .......��_ ...... <br /> _ ......_:... ..__....._....._...:.. .- <br /> _.._ max. . -- --� � �J—--------- - <br /> --- -- --- ---------------------------------------- ____...... ...,..............- - <br /> (Draw existing and reG allOFTIOn On reverse s: e r 1 <br /> 1 hereby cerflfy that 1 have prepared this application and j�at the work willsho,elons,in accordance with Son Joaquin eouoty <br /> Ordinances, State Laws, and Rules and Regulations of,the San Joaqu n Lecal Naeylflt?Oisfritl, Home owner or licensed agents } <br /> signature certifies the following: - 1 - j q� <br /> "1 cern that in the V /� <br /> certify performance of chs.work tot which This perh�ii�is issued, ! shall not employ any pSYso� In such manner as <br /> to become subject to Workman's Compensation laws of_Colifomia" ,( ' <br /> Signed '/..'..� ' <br /> By.K. � s IArV[tutu[- ... ... .. ... ... ..True <br /> 4 (If other than <br /> FO EP TMENT Llk ONLY f <br /> APPLICATION ACCEPTED BY.-----•- ---... -------- - - •- ------------•-•-.:.-.:..-•-�-•-•-----..;...DATE." �a - --��--- --------- ' <br /> DIVISION OF LAND NUMBER;--••--`----- -- -------- DATE....::.: .... ......:- ----- <br /> ADDITIONAL COMMENTS. - - - -. + <br /> i �rr..er/`�"- <br /> r r, .,..� <br /> - ' --- - - - - <br /> - --------- - --- -- - -' . <br /> Final In spection,by:.... _ ' '� '"• Datf%j'-- - - ----------.. <br /> M 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21sn ssv.rrrs sat <br />