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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------- .............. <br /> (CpMpIetiP_injripIicote)___ Permit No.... <br /> ............... <br /> ...........I..................... ................. This,Permit Expires-,i Year,From Date Issued Date Issued <br /> , - - , , 11 2 2:70- J- <br /> Application is hereby made to the S1 Joaquin Local Health District for a permit to construct and install the wXk herein describe, <br /> This appliconion,is,mocle in­complionlo­with-County O,dinanci Nv-549`6`5­51'egfil JR Ie,-and-Regulations------ <br /> JOB 4D Ji�—:_C Ek_S_U S11-R AG:11��------ ...... <br /> DRESS/ 74ON....I....... Cir—...L.-_K�-iif .......... <br /> L <br /> tt <br /> Owner's Name----------K.14z &_c,---------- --------------- ------------Phone-JW-7- <br /> Addrel. <br /> s. Z y ------------I........ <br /> .. ............... <br /> L <br /> C So .414fA Phone- X- <br /> Contractor's No ne---1-6--_,.7.44!774 1dir I en <br /> tallition will.serve`i—T__R6e2i_n_ce,& Apartment House.E], I Commer'Et -0—Tr-blier Court Lj A <br /> :,Motel [] Other!_------_--:?.t�---------------------- <br /> I-Grinder. <br /> Number of,living units:......L!---- Number of.bedrooms...9...._lGcirbogdj -..-,,.Lot Size.............. .... --------- ------- <br /> Water Supply: Public System and name--------- ......... .......... ........ .............L7------- ---------1-r-..........Private <br /> '. 1, . '� �­ zr��Character of'4.oil.t'b ci,ciopth of 3 ftiet: Sand [] Silt tD Clog 0 Peat p Sandy Liam 2 Clog Loom n <br /> kn,,h, 1114trdponi Adobe 0 Fill Material........ If yes.,type............................... <br /> (Plot plan, showing'slisNoFlot, location of system in relption-to, Ills, builclings,'etc. must be placed on reverse side.) <br /> NEW ]INSTALLATION; '(No�septic tank seepage M . 1 200 fe I <br /> or seepage pit permitted if public sewer is avrilable within et.) <br /> SE <br /> PACKAGE TREATMENT 4SdTIC TANK Size-...-,----- A-------------Liquid 66pth........................ <br /> Capacity!-.-f..::.:-----..Type---- - ---- t Mcrterlol------ -------- - ------No%Compar.tments-' <br /> ....... ------ <br /> Distanceito.neorestWell : ...- - _ --Foundation - Jsa . PropLine --- <br /> LEACHING LINE No. of Li .................... Length of Poch I!p@i-----------------�­ .tot, I Length.�...... --- -------------------- <br /> 'D' Box.] .-Type Filter Material........t.....:...-.bepth Filter Material... .......\............ ....I........................... <br /> Distanco:to nearest;Well �..... ..............t----Foundation ------ ------- .... .. ...Proper!y.Une.-;------ .. ------ <br /> .$EEPAGE PIT Depth..�. ----Diameter-...... ---------Ntmlosr----------.............I-------- i Rack Filled Yes 0 N <br /> -------------------- <br /> Water 15 tF _Kock Size.------- ----------7 \1 <br /> ---bistance.16.nearesfi-Well _F6unZIafion................s.........Prop. Line.................. <br /> ZREPAIR/ADDITION prev!Sanitation Permit#........ -----------------tic Tan ....... 9/ <br /> 2SEijok (Specify Re -) ----- ------- .. . ............ D ate...............:---------- -- ------ <br /> -- - -----.---a..... .. ............ .......... -------- - <br /> lk 146 <br /> I'bisposal Field (Specify <br /> .....TA_1v.R--- <br /> ................i- <br /> ............. ---------------- ... ... -- ----------------- -- ---- --------------------- ---- ............... - ---------- ---------------- ------------ ------- <br /> LCL, tx 1 1, 1 . - <br /> qW �istigigjini;Lrequired addition on reverse side) <br /> IPro kircisirtify that I have preparecl application and that the-work-will-be-done -acc*rlicince with Son,Joaquin CouAl <br /> OdIna i6s, State Laws' and Rules land Regulaiions of the San Joaquin Local Health District. Home owner or licensed ages <br /> signatu.re certifies the f.ollowing: .1. <br /> -I certify that in thii'.0ir I f6rmahce of the work far which this permit is. lssmojd,,l sholl <br /> not employ chy person in such manner c <br /> to i <br /> Signed__IFA A" ­------ <br /> _4PAV....... ......:............ . .......Owner <br /> B0.... . .. <br /> .. . ...... ......................... ..............Title........................ --------------------------- <br /> if or than6wnerl r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_.- ------ ------j- <br /> .............. ..........DATE...... <br /> DIVISION OF LAND NUMBER:-----'---- ........ ---------- --- ... ........... -------:......_-:.--DATE.'._--.-:......--.--- <br /> .................7 <br /> ADDITIONALCOMMENTS..... ........... ...................................... .......................I-----------------I.......... . ------------------ <br /> .......... .................................. .... ................. ----------------------------------- ........ <br /> ----------------------------------------- ................ <br /> ------- --- ------ <br /> --- ------- ........... . ----- - <br /> ........................... ... ............. ........ ­ <br /> . .......... <br /> ------------­----I.................. <br /> Final Inspection by: .. ...- -------- . ............. ----------------------------Date.xe. . ...... <br /> N 13 241 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 216n REV. 7/76 <br />