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,. FOR WFICE USE: } APPLICATION FOR SANITATION PERMIT ; 2 <br /> A '7257.5" �{ Permit No. <br /> l f ....._-..... (Complete in Triplicate)i <br /> 9 <br /> .............- '--- '-- ......_ i }} Dare Issued ..7'z_..'. <br /> --- <br /> This Permit Expires 1 Year Frain Dat Issued -- <br /> -------------------- <br /> Application is hereby made to the San Joaquin Local Health District-for'a pertto construct and install the work herein <br /> described This application is mode.in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> (�J.. ,.--------::..GENSUS TRACT ...a _ <br /> .�� ..._ <br /> JOB ADDR7ii <br /> #101 '.'"' • - ons <br /> Owners N _. ._ Q.� T=-'-------•Yt -i�i..-----L:d -• � :------ ---- ___....__..... <br /> do '-� OttiC --- - city .-- j� - • - <br /> ----- <br /> Address .... .. <br /> Contractor's Name...�ti{,/J�•�` •-� _-_..-.•--- - <br /> -..........-•-....-.......• <br /> ---....Li se dt -----------�._. Phone - '-------•-------.-_.._ <br /> �� �Troiler Court 0Inatailation will serve: Residen <br /> adP� 1 <br /> Mote► r-------------------`---------• - ---• <br /> t . Cxindor .. - <br /> -_.... Lot Size As <br /> Numbir of liJ�rsz <br /> ving+ - <br /> units:- -f ---_ Number of bedraornE„_. <br /> V` <br /> - <br /> Water Supply;• ubTit System and name -- -- - -.. _. . ------ ---•- _ - • <br /> tt I "pea} +�$pn'dy'Loam Clay foam/[] <br /> Chars&er'of sail to a depth of 3 feet: Saha ] $TI�� lay If; es ��^•�� � <br /> I Hardpan Q Adobe Q Fill Material --' ,r type -�fT ` <br /> I I <br /> s Lo to we laced on reverse side.) <br /> (plot plan, showing size of lot, location of system-ia..relpl_c�:__.IIs, buildings, etc, must.be� 1 <br /> NEW INSTALLATION: (No septic tank or seepag pit pgrmitted if p�u lic sewer is available Wit <br /> him$0`0 feet,) y <br /> rr x.._ .------- Liquid Depth .._,._ { <br /> PACKAGE TREATMENT I I SEPTIC TANK y 1 <br /> py r - Mater No. Compartments ----------......__ � <br /> tj <br /> Capacity <br /> TYPs u n .�Q t.... Prop. L{ne - I 1 <br /> 3( t <br /> � fo ndaho <br /> Distance to nearest: Well !- --•'- <br /> LEACHiNG_aINEt- rat—tip. of Lgnes p - ...._._..Len9 4e� '1`- A& - ---- Total Len` H+ .'z�:� <br /> r � z Boz Type Filter Mater`al '_�-✓- 'depth Al�ttee7r Material .----/-. ----.......... - -_s_-_- <br /> � i ---�u' --f.-- Properf�ILine --- -----' ---- <br /> :2� . Foundotion No ,0 <br /> Distance to nearest: Well ..�+U----- ` <br /> v� i <br /> ' Depth Diameter __.-_. Number --.------ ----------------- Rock Fill Yes <br /> SEEPAGE PIT" [ I -- - - ' <br /> I. .-Rock Size <br /> ter Table Depth - ---------�_....----_... - ! <br /> I r t 7 ----•- Lina <br /> Distancb to nearest: Well ---_-�-.:....._---•---:----•-•-•-•_ Foundation ...... -�Pro -- <br /> 1 otsi -.-•--^- -... <br /> REt' ADDITION . Sdnitatiai Pet rf nrt :--------•---•• <br /> _._.._...__._. _............_.......... ------- <br /> (Prev Septic Tankpecify Requirements{ ------- --_-_....__........._._.........:............� <br /> r.... .........-----•-•----....._--.....____..___..�.._---- <br /> Disposal Field (Specifyi;Requirementsl 1 <br /> t <br /> I <br /> �•4 <br /> Wrow existing and required addition on reverse side) <br /> i hereby Zbrl ytt+at 1 have Prepared this application and that the work will be done in accordance with Sah+iJe icen- <br /> Counry'Ordindnces, Stote;Laws, and Rules and Regulations of the San Joaquin local Health District. Hems ownir,er 11cen- <br /> sad agents sigbature earhfies the followings�, y, - tch this..FJrn_.°it is is�.d,_.1..s.h3i):net smPiey any issrsen in suck manner <br /> "I certify that in the Parloiinoncerof_the wodc� which . G <br /> J <br /> as ro"me tubject t krncsg4 g4 -n laws GrCiYifoinia. / <br /> ( r <br /> Owner <br /> Signed!.- —...... <br /> .i _..- .. <br /> - <br /> t <br /> --- - - <br /> Title -- <br /> w-z- -----..By . LX7a <br /> _ <br /> Kotber than­owns;S <br /> DEPARtMENT USE ONLY <br /> I DATE ... ....>� j/ ' <br /> APPLICATION ACCEPTED BY + ...._..... -..... •---._..---- - - - - <br /> t BUILDINCrPERM1T ISSUED:......._.:-. -::_--- r- ':.<- _= < .::.::r:—°=--• - .....ti - <br /> ADDITIONAL COMMENTS V'l L .t ...... -------- <br /> ------------------ <br /> - / <br /> • - •- - -----• -- .....Date . <br /> Frrwl,lnspectio SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1 � <br /> �..1=68 Rev..5M. <br />