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TION FICA SANITATION Permit No-. <br /> FOR OFFICE USE: ION ftWd (,/- <br /> APPLIC . .... <br /> ----- -------- (Complete in Triplicate) <br /> ------------------------••-----•-.__.. .I <br /> Date Issued <br /> -------------- •..........-••-••..._.---_ ;his Permit Expires I Yoarl!,!o�n Date issued .1 Nklk <br /> .............. -------------- ------ ............... <br /> I N it to construci--and install the work herein <br /> Application is hereby mode to the son Joaquin Local Health District forN., per'm d Regulations: <br /> d"in compliance with County Ordinancel-IN.,o. 549 and existing.Ruies on <br /> described.This application is made' kk �ENSUS 'TRACT ......... ---------- <br /> JOB ADDRESSAOCATION <br /> - ----------- ...... ...... -------Ph��---1�-------------------------------- <br /> Owner's <br /> city <br /> Address JV&Lp----- ------ <br /> V_ !cerise :�< Phone ------------------------- <br /> ...... ....... <br /> Contractor's Name <br /> Installation will serve; R e sideInce Apartment House Commerd'al..0TWile'r Court 0 <br /> Other <br /> I ............ <br /> Motel 0 or---- <br /> Grinder __T=r= Lot Size _7=1____---------- <br /> Nvmb�r of living units:. Number of bedrooms ---------- -Garba.ge Grin ........................•........Privatd <br /> Water Supply.public System and name --------•-----------•........... --------------------------- <br /> I clay 0 Peat❑D Sandy Loom 0 Cla�.Loom 01 <br /> feet: Sand 0 Silt 0 <br /> Character of soil to a d6pth of 3 1 --------- ---------- <br /> Hardpan Adobe 0 Fill Material ------------If Yes,type------ <br /> ings', etc. must be placed on reverse side.) <br /> (plot plan, showing size of lot, lo'cation of system in relation to wells, build I :r, -, <br /> ff blit sewer is available within 200 feet&\ 0 <br /> NEW INSTALLATION, I jNo septic tank or seepage pit permittedI P p� <br /> - I SiZA/A_11d./V �X- <br /> -------------------- Liquid Depth IV-`,------------ <br /> EPTIC TANK JX No. Compartments -2 <br /> PACKAGE TREATMENT 5 nts a;.......... <br /> Cc pacity lisgp-_Q------- Type VAAe,6,40` Material.e4tb�- X"'o <br /> ................... <br /> Foundation .....JJR---------- Prop. Line -_ <br /> Distance Ito nearest- <br /> P14 Well -_....._..IP A... <br /> I .......__--- Total Length <br /> - of each line--- ........... <br /> No. of Lines .....A.............. Length <br /> LEACHING LINE ......... q <br /> .......Depth Filter Material ....if------_---------- <br /> D' Box Type Filter Materia <br /> ----------- Property, Line ------ ----------- I <br /> Foundation -----10... <br /> IDistan Frnearest; Well .......... Rock Filled Yes No 0 <br /> Depth Diam6ter .:qU ...... Number -----------2------------- <br /> SEEPAGE PIT (4 -- <br /> Water Table Depth --------------------------------................Rock Size ---------------------- --------- -f <br /> ................. Prop. Line ....-------- ....... <br /> Distano4i!to nearest-Well .................. .....................Foundation --- <br /> . .................. <br /> REPAIR/ADDITION.(P rev)So nita�ilon Permit# ..........................................� Date --------------- --------- —C <br /> ........................................•_••----...._._----•-••------- <br /> ------------------ <br /> ----------------- <br /> Septk Tank (Specify Requirements) ----------------- <br /> I 't t5l _.......... -------------------- -------------------------------------------------------------------------------- <br /> f� Requiremen ---------- ".. 1.:.. k <br /> Disposal Field (SPec! ----------------- <br /> -•-----•----•---•••--- <br /> --- <br /> ..................... <br /> -------------------------------------.......­------ <br /> ------------------___.......... <br /> ----------------- A (- ------------------------------------------------------------------------I---------- <br /> I ........... <br /> --- - - - ------ <br /> ------­-------------------I------------- ---------- ------------- existing-st-1.ng-_a-n-d.-required,addition on reverse side) <br /> (Drawth at -1 the woj�' llie d4ne in accordance with Son Joaquin <br /> 'cqnify that I have prepared this pplication and licen. C <br /> 1 hereby, 10, ..)"rquln L�cal�Health District. Home owner of <br /> and Rules and Regulations of the Son <br /> County ordinances, Stat� Laws, <br /> sed agents signature cettifilis-the following- <br /> .h this permit,is issued, I shall not employ any person in such mariner <br /> I certify that In the performance 9f,the work for whil <br /> km.ar�,s Compensation laws of Callforn&�,;, <br /> as to ,"am,, subject to War <br /> SignedA. r---------- ------ ........................... ........ owner --------------- <br /> ------------------------- <br /> By......... <br /> (if other th6n owner <br /> FO 1.-DEP <br /> AXTMENT <br /> US <br /> E ONLY <br /> ---- --- il <br /> - �E <br /> .-_4-i?. <br /> APPLICATION ACCEPTED BY's- - -- -------aATE ........................ ................ <br /> ------------------ ................... ............... <br /> BUILDING PERMIT ISSUED---- ------- ---..,y <br /> ------:------------------------------- <br /> ----------------------­-------­_­­--- ---- ---------- . .. .... <br /> ADDITIONALCOMMENTS-------------------- .................................... <br /> _�Z---------------------------- -------------------------- ---------- ...... ............ <br /> ---------------------- .................... -------------- ----- <br /> ------------------------------I------- <br /> --------------- <br /> - --------- --------- <br /> 11 <_�.............. . ....................I ---- -- <br /> ......... ------------ <br /> --------------"__­..... <br /> Final Inspection y- ---------------- <br /> SAN jOAQUIN LOCAL HEALTH DISTRICT <br /> F. H. 9 1-'68 Rev, 5M- <br />