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FOR OFFICE USE. a �'APPLICATIW—FQ111:6ANITATION PERMIT, <br />mit Na <br />.—Per <br />(Com j <br />plate in Triplicate) <br />...... Dote issued <br />This permit Expires,] yOur From Date Issued I <br />Application is hereby made to the Son Joaquin Local 'Health'DI strict for..,of permit to construct and install the work herein <br />:Inc on i ti Rules and Regulations: <br />described. This application ism de in, com iiante with Couhty, Orclin;pce No.,549 d ex�ls I <br />LAI <br />/iy,.#tr.4'�IONSUS TRACT ... ... <br />ION A _ <br />lion ADDR8SS/L( A <br />...Phone ....... .......... <br />Owners Name <br />... _10ty", <br />421 <br />Address <br />Phone ....... <br />71d_4 <br />Aicense 0 <br />'Contractor's Na . ..... ......... ...... <br />Name. <br />)Installation will serve. R iider)ci ✓artmerif House Cornf4rcicil CITrciflar Court <br />Other <br />s 44-c-,* ... Lot 61z <br />Number of living units:,. .... �Number of bedrooms _.,2..,Gor.bage Grinder e <br />11 1 / <br />Water Supply- Public System and name ........ .......... ........ ------------------------ - ....... ...... <br />Private <br />- <br />.0 Clay e —1 Clay Loam <br />j p at C] Sandy,Lopm L <br />Character of soil to a depth of 3 feet, SandE] Silt <br />Hardpan' FI-- Adobe Ey Fill Materiol D if <br />yes, type <br />. .... . .... <br />JPtot plan, showing size of lot,!Iocation of systemin relation to weIts., buildings, etc, must be placed on 'reverse side.) <br />NEW INSTALLATION- (No septic tank or seepage pit permitted jf,public..sewer is civailable'wit in 200 feet) <br />�rLi� id Depth <br />PACKAGE TREATMENT f I SEPTIC TANK I . ..... <br />artr�ehts-, ---_------ <br />y No. Cofv�p <br />capacit, .... Type,&*_ ZO <br />Distance* to nearest: Well..... EaunclationV,.' <br />Tot( <br />LEACHING LINE No. of Lines Length of ine,/. 21 Length------................ <br />Ty -- ----- Depth Filter Material ....... <br />_pp Filter Material <br />inr ......... <br />Distant to nearest: Well f8unclation Property L <br />Diameter kJ]J� 1!14�bii <br />Rock Filled, Yes No (3 <br />'SEEPAGE PIT Depth <br />Rock Size - <br />.... Ro. ........ Z <br />Water Table Depth <br />I e 061ndation prop. Line <br />Distance to nearest- Well ly.q,�o ...... 4 ... ...... F' <br />REPAIR/ADDITION JPrev. Sanitation Permit# --- ...... Date _.. ....... <br />...- ----- ...... <br />Septic Tank (Specify Requirements) r7�_i.777� .... . ................ ...... ....... <br />ts) ...................... ................ ...... ............ .......... <br />gisposal Field (Specify Requirements} <br />...... <br />.......................................... v- .... K.,:. ......... ...... <br />............ ...... ­­ ........................ .............. <br />(Draw existing and required addition on reverse sidel <br />thereby certify that I have prepared 1this application and that the work will be done in accordance with Son Joaquin <br />f the Son Joaquin Leval Health District- Home owner or licen- <br />sed <br />Ordinances, State Laws; and Rules and;4egulations a <br />sod agents signature certifies the following' <br />"I certify that in the performance of the work for which this permit is issued, I shall not employ any per%*" in such mannan <br />as to become subject to Workman's Compensation IOWS Of 'California." <br />Signed .. ........ Owrve <br />rrJ <br />TitleBy . ......... iz . ......... <br />(if otherth­ nen) <br />FOR DEPAtTMENT USE ONLY <br />APPLICATION ACCEPTED BY__ ...... DATE <br />FOR <br />1 - DATE ................................. <br />BUILDING PERMIT ISSUED__. ............. . ....... ------- ...... ......... <br />........ ................. <br />ADDITIONAL COMMENTS. - --_---------- ;_�� .. .............. ........ <br />_­ ................. <br />...... 7 ................ ......... . ...... ...... <br />.................... ........ .......... . .... ......... �nJ. ...... <br />00-�'. .4. ...... <br />ate.......... <br />Final Inspection by; ................ <br />SAN JOAQUIN LOCAL HEAL�H DISTRICT <br />E. H. 9 1-'b$ Rev. 5M <br />