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APPLICATION lto�jt SANITATION PE I; <br /> _.:..._ . <br /> .....-:..:..........:............... <br /> !Complete in Tripl#tate) Permit No. <br /> „„. _. P... <br /> :.....�....................... This Permit Expires <br /> D <br /> ........................... pires 1 Year from Date Issued e ..... a <br /> iQ ...._... <br /> Application is hereby made to the San Joaquin Local Wealth District for a permit to torts <br /> described. This application is made in com liance with i all <br /> t e work <br /> P th County Ordinance No. 5 9 and existing Rules and Regulations" <br /> " .IOB ADDRE �1O . <br /> SS/LOCAT#ON ..-_. CJf�14^ 2 P <br /> Owners Name C�:...f G O CENSUS TRACT' ................. <br /> ...................... <br /> I ( Address . _... l�'.,�. .t�s. -_. . Phone <br /> Contractor's blame .. . ,�: r.. Cl ..............................� .. =E. .... <br /> License #CP/* Ph �:. <br /> k <br /> Installation will serve: Residence Apartment House Commercial ane ls: <br /> k oTraller Court <br /> Motel p Other <br /> ......... . . ... <br /> il Number of living units:_._. N -:........:...:./.... umerobedrooms ...... <br /> Garbage Grinder ....--- Lot S!Water;Supply, Public <br /> . ... ...tem and name .... ....,.. <br /> Character of Abil to a depth of 3 feats Sand ............................................... Priva#0'( <br /> E3. S€Ir(; Clay [� Peat p Sandy Comm IV Clay Loam <br /> Hardpan 0-: :Adobe 0 Fill Mi Wlal ........ .. If yes,type............... ... ...... <br /> !Plat plan, showing size of 'lot, location at system in relattton to wells, buildings, etc. must be placed an reverse si <br /> , NEIN INSTALLATION: IN* septic#ank.or,$ee a it permitted 1#public sewer-is available within 200 feet,} �.} <br /> p� 1? <br /> PACKAGE TREA P <br /> TMl:Nt [ � SEIsTI�TANK i ] .!�....1� / .. . <br /> �a'� 4' Liquid Depth .. �3! j.. <br /> Capacity �:Q .. Type Fg�..G':��aterf�._:... .. <br /> No. Com rtments' .. <br /> 1 ! .. <br /> Distance.to nearest: Well -- .-� ................. / � � <br /> ... <br /> f'Ot1 <br /> ndation .1�...,,...... Rio Line... 6..._ <br /> . <br /> LEACHING LINE ... <br /> ( ] No. of !#nes ng t►e... <br /> le th of each li <br /> ' Box / . ...... Total Length :�.......... O <br /> 'D, �,. Type filter Material 1. <br /> pth filter Material ... <br /> Distance to nearesb We II _...~�� 1 ,(! --i ... <br /> . Foundation G2....._...:.... Property <br /> Nunsr— <br /> =� .....Rock Filled—Y <br /> Water Table Depth .... .............. <br /> S <br /> �•-tack ize Y <br /> 'Distance to nearest: well . cuhdatio <br /> 11EPAiRJADDIIIQN lPre+r. Sanitation. rmit+p - ,....._, :. r ..... Prop. Lira¢ ................... ; <br /> ..., nitation. Pe <br /> 5eptiC Tank S ec# Date ................. •} a f <br /> { p fy Requirements �.� <br /> Disposal Field S eci } l.. ...._.� .-- <br /> ...... <br /> 1 17 fY Requirements} ' v�� z/ <br /> .------ <br /> ---------------------____........ <br /> { q <br /> i©raw existing a ...I...... .......... <br /> i nci required addition ort reverse gide} <br /> I hereby certify that t have prepared this application and than the work will be done in accorda�rtce with San .faaquin <br /> County ordinances, State laws, and Rules and Regulations of fhe"tan doq`puln Local HeQ#ll�Dis#r(tf. Home pruner ae licen- <br /> sed.all Pis signature certifies the following: . <br /> l certify that in hop orn+ante of the work for which#hi` permit isil$t'v d,•1 shall na#•employ.cony person n such manner <br /> as to beEome sublet a ma ' am ensation laws of C911fornla"". <br /> Signed r <br /> . . --- <br /> : . ....................... Owner <br /> .-- -----•-- <br /> --•----- ...•... title <br /> --1if other-than owner!. ........ . <br /> oP FOR DEP LRTMENT USI: ONLY <br /> ,. <br /> APPLICATION ACCEPTED BY __. <br /> BUILbING PERMIT ISSUED - - <br /> DATE. ' r :77 <br /> ---- - -------- <br /> ADDITIONAL COMMENTS -. ----- ---•- DATE - = . <br /> .---•---- <br /> --. <br /> ---- --- <br /> Final Inspection by; ....... ------ ••--�—•• <br /> ?EH 13 ^t 18 Rev. ._ •---...._- - •----- --- ........ -- ••---- ate <br /> S - •---- - ------ ......... <br /> ' <br /> JOAQUIN LOCAL HEALTH DISTRICT $/71; 3M <br />