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FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .. <br /> (Complete in Tr(plicahl <br /> ............................... ....................... _. .. Date Issued <br /> This Permit Expires 1 Year From DO*Isseed <br /> r< Application Is hereby mode to the Son Joaquin local Health District for a permit to construeand ng <br /> a the want het+efn <br /> 519 and existi <br /> desaibed.This application is made in compliance with County Ordinance No. ng Rules es ax! Repu(o11ot"" <br /> +,~ JOB ADDRfSS/LOCAT,I�ON1,l. ���.. �-f... (7C ..........CENSUS TRACT <br /> Owner's Name . ._. p. .... ...............Pi,one <br /> ....». <br /> ac" Address ...............l.�f••!• 3. ..•...I -`... CC. � "City ... .....................,......... 6 J- 6 . <br /> ' Contractor's.Name ......... ....... LL 7 .... ...�1 Y .. ..................,License Z5 `3�:�.... Phone t... .......... .... <br /> y House Commercial roller Cae <br /> Installation will serve: Resldence�J Apartment <br /> Motel❑Other......... ................................ <br /> Nui»bsK of living units:...../... Number of bedrooms ... .....Gv bags Grinder ............ Lot Sire ...lQ..�- "T ........ <br /> o r Wow Supply: Public System and name ......................................................_..`_.. ...................... .... <br /> Character of soil to a 4opth of 3 feet: Sand El Slit Q day 13 Pow 0 .,Sbndy Loam❑ Clay Lean LJ, 't <br /> �taF <br /> Hardpan Adobe Fill Material.... Ii yw,type............ <br /> . <br /> ........ tt+SR sZ 1 <br /> (Plot plan, Showing size of lot, location of system in relation to wells, buildings, etc. Trust be pksoed an '/reMNM uNde•( <br /> TjfbJ' t °•.' <br /> t ` NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is avalk"e wlddn 400 690#1 r <br /> PACKAGE TREATMr"NT ( ] SEPTIC <br /> TANK I ] else...................:.......:................... L{ePiid�hDrp111 �- ...- <br /> Carty .................... Type .................... AAcde.............. No. CamporhrnefMs m. :. ... <br /> Distance to nearest: Wall .................................Faertd`ation... .......Prop.Lim <br /> 1 H ». <br /> LEACHING LINE . ( J No. of lines <br /> ........................ Length of each line....................... Toro) <br /> Length <br /> 'D' Box ...... Type Filter Mu?erial ....................Depth Filter MatorkA <br /> Distance to nearest: Well Foundation ........................ ProlmiylLineJ.., F <br /> Number ..... Rode Filler! Yes ❑ <br /> Diameter ............. <br /> ... ..............:........ <br /> rq SEEP/tGE PIT ( ( Depth .................... ' <br /> ' L` Water Table Depth .......................................».......Pock Size ........................... <br /> Distance to nearesh Well ....................::............:.::..Foundation .. » kap. Line . ...._. <br /> REPAID/ADDITION Prov. Sanitaticn Permit f ...................... Date .............. <br /> Septic Tank (Specify Requirements) .................... . �........ ..__................._ <br /> ;. <br /> .... -• ••.... <br /> Oisposai Field (Specify Requirements) ....K-- """"""""""" <br /> �3...X.. :5...` <br /> - ... a ... <br /> ........... ..................... .. <br /> .................................................................... <br /> •----'-'....................................•----._.........................---................................................... <br /> p.. . <br /> (Draw existing and required addition on reverse side) <br /> �11I herby certify that I have pre erred this application and that Ma wok will be done In a wdcasee with Sits iee4+� <br /> County Ordinances, '.:.'. saws, and Rules and Regulations of the Son Joaquin Ltcai H0411* DkWd. euse Nowner or new <br /> sed ogonts signor the following: <br />- • ti "I certify that in once of the wok for which this permit is issued, I shall not employ <br /> myov saanrsM <br /> -' as to become sui: •,ekman's Compensation laws of California." <br /> - mer <br /> 1 iiZ .... .................................. <br /> Signed Ow <br /> ............................ . <br /> By ....... ............ .. .... ......... <br /> (If o: ern owner) <br /> `j FOR DEPARTMENT US' ONLY <br /> <.FPLICATiON ACCEPTED BY.....�.-.. d .. ... .. ............................................................ ..... <br /> DATE Z,.. . '..! ................. <br /> � BUILDING PERMIT ISSUED ...................... DATE . .-..................................:.. <br /> ;;'. . ADDITIONAL COMMENTS _............................................ ............................................. <br /> F <br /> :::::::::::::::::: ::::::::.: ::::::::::........ .......:::: :......:::: :: :::::::::::::::::::.::::::::::::::: : ::::::::::::::::::::::::::.. ....................................................:. . .... <br /> ..... ... �. '. Da►a .. . . . <br /> _} Final Inspection b :..aJ ' ................ .......................... . <br /> .. .. .......................... <br /> 131 13 21, 1-6B Rev. 5M AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />