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0 19 <br /> FOR OFFICE USE. 11- <br /> FOROFFICE USE: <br /> APPLICATION fOR SANITATION PERMITKomplett In Tripllcatel ermitNorte— Y.4 y IThis Permit Expires 1 Year From Dote Issued Dts Issued/D-.161y <br /> Application is hereby made to the San Joaqu.n Local Health District fo, a permit to construct and install the work herein dowribed. <br /> This application is made in compliance will' County Ordinonco No 344 and exhting Rules and Regulahons: <br /> JOB ADDRESS/LOCATI N /t> CENSUS TRACT <br /> Owner's Name I <br /> a Phone <br /> Address ✓ i. .:. /"� ... : ' �.'i. '-. Clry V! el" i)(_. Zip <br /> Contractor's Name Pie ' ,,.A�c, . .._ License • _' , ' phpse <br /> Installation will serve. Res,decre [7 Apartment House Commerciol>,� Trails Court ❑ <br /> Motel ❑ Other .._ _. ,/ ` <br /> Number of living units. Nvm:.or of bedrooms Garbc go Grinder . . ... . .Lot Siae,.Zfec alt`/"'� <br /> Water Supply: Public System and name _ .. .,. Prlvae sV <br /> Chorocte.of sail to a depth of 3 (ear. Sund l] Silt [i Clay ❑ feat❑ Sandy loam Q Clay Loam❑ <br /> Hardpan ❑ Adobe Fill Matenal 11 yes, type <br /> (Plot plan, showing sits of lot, location of system in relation to wells, buildings,etc, must be planed on reverse ado.) <br /> NEW INSTALLATION: (No septic funk or seepage pit permiftod :1 public sewer is available within?W feet,) r <br /> PACKAGE TREATMENT ( ) SEPTIC TANK ) J Site Liquid Depth V <br /> Capacity Type Mufw,ol No Comportments <br /> Distance to neatest: Well Foundation Prop. Line <br /> IEACH;NG LINE ) ) No. cf line' longth of each line Tato) Length _ <br /> 0 Box Type filter Material Depth Filter Material t�s <br /> O:stanco to neo,est- Well Foundation ion Proline piar <br /> m <br /> SEEPAGE PIT ) J Depth Diameter Nubo, Rock Filled Yes E] Q <br /> No t <br /> Water Table Depth Rock Site \� <br /> Distance to nearest Well foundation Prop. Line <br /> REPAIR/ADDITION (Prov. Sanitation Derma 0 Dote ) <br /> Se; :c Tank (Specify Regvnements) / <br /> Disposal Field )Spool•• Requirements) ��— <br /> ri <br /> r <br /> (Draw existing and required addition on revere Ude) <br /> I hereby unify that f have prepared this application and 1:rat the work will be done in accordance with Son Joaquin County, <br /> Ordinances, Stott Law,, and Rvlot and Regulations of the Sen Joaquin Lescol Health District. Nome owner or licensed wants <br /> signature certifies tht following: <br /> "I certify that in the performonce of the work for which this permit is issued, 1 shall net employ any person in such mon"er sis <br /> to become subject to Workman's Compensation laws of California." <br /> Signed ✓• :. _ - Owner _ <br /> BY .6.._ .. . . ' .r. . . Tile <br /> (if Gther than owner) <br /> FOR DEP TMENT USE ONLY <br /> APPLCATION ACCEPTED BY �'/L+� 't"e^/ DATE 6 7Q <br /> 0-VISION OF LAND NUMBER / DATE <br /> ADDITIONAL COMMENTS - <br /> Final Ins"C"on by c r/ L /LICttL� Date <br /> S%,N JOAQUIN LOCAL HEALTH DISTRICT :as 1161, .11 are'+ <br />