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. ` <br />' <br />FOR OFFICE USE: <br />^^� --- ` <br />'4 FOR OFFICE USE: <br />APPLICATION� °, <br />�OASAN|TATON PERMIT <br />- (Complete in Triplicate)} <br />| - <br />��-- Permit <br />This Permit Expires l Year From <br />I Application is hereby made to -the S n Joaquin Local' Health District fo'r 'cr permit to construct and install the work herein described. <br />This CIPPlIcation is made in compliance with County Ordinance No. 5A9 and existing.Rutes and Regulations. <br />Installation will serve: Residenceg -A <br />Number of living units;.... y <br />Water Supply: Public System and ncime_.. I <br />Pth of 3 feet: .Sand t El Clay Peat F <br />_] Sandy Loom Ej Clay Loom <br />Hardpon Adobe El --Fill M&`rial.. <br />(Plot plan, showing size of lot, locationof system in -relation to'wells,,Lildings, etc, must be placed on reverse side.) <br />NEW INSTALLATION: (No septic tank or seePage,pit permitted if public sewer is available within 200 feetj <br />PACKAGE TREATMENT SEPTIC TAINK <br />Size <br />' . '.o. . <br />_-..`~.""e"=^' <br />- WelIT <br />LEACHING LImE N <br />� ' / <br />.'_Filter--_-...^^~-_ ^=� �=p`n�v=rvoom / ���� '�~~� � <br />Distance. to nearest: Well ----- Foundotion._/O!�- <br />Filled 'Ye a. <br />SEEPAGE PIT i] ���� �--` Line ~'~~ ^^ � <br />� ----~~~~--^....�". �°» � Rock <br />Water / <br />. ---Rock �--- <br />Distance m neae,t_ -.5*~�-- '0P-ro-�p- <br />. °=)i <br />i^n°e��--`--�-'mEPAUu/ADD�|ON (p�'. Sanitation permit #----_----'-----Dq�� '----SepncTonk (Specify Requirements) r -------''`-----------^---'-----------'-------- <br />Disposal Field (Specify Rwqui/*n�n�v)-�t!-'-�-�..'---'_----. <br />.� , ---'-'__-'-.---_---_-''__-'_'----. <br />--------------------i . <br />�_-__._________.. <br />'--------------------.� y ........------------''-^ ---.'-' - .� � ----'-.-'_-'-----� <br />.'(Draw existing and required addition on reverse side) ------------- <br />I hereby certify that I have <br />Ordinances, State Laws, and Rules and � .c-, ccordance with Son Joaquin Cnmmtr <br />~/\ Regulations- - the ~~^ ~~~q°"' ^�"w' Healthm District. Home owner o, licensed agents <br />signature the fmkovw <br />ng- <br />' certify^that ' of <br />' v�U��em����������hm�n=� � <br />'~ becomes1 <br />-�'---«--~---�-°� U-sation laws oF California.- <br />'',--------Owvne* �^ - <br />B^.�..................... .�w <br />----------' '-'-----_--'Ti�o.---'_-- <br />(If other than mw ---------------- <br />.� � <br />DEPART!�ANT USE ONLY <br />' <br />' <br />APPLICATION ACCEPTED 8Y .... <br />DIVISION OPLAND NUMBER.__:... <br />ADDITIONAL COMMENTS ... ��������''��������_ <br />---^-'----------'---- <br />b�- �---------'- <br />DATE <br />'-----------;"-----'-��----�� <br />�. '--�-''------------ <br />V­ <br />....................... <br />------'-'--- <br />` - °�_.-....--'----.--------------.'---'----_ <br />---��-'--------'.r��----',i-----____________.__:_____.. <br />.................. ................................ ....... <br />......... ....... ............... <br />ino/in:paotonb�_---.�����" ---'----'----' ------- -�-'-+� <br />' ---------.--------------� Do����/['^�� <br />Nmm -� ' ' ----'-' <br />^ ' ---' <br />. ���JDAQU|NLO[AiHbALT*DISTACT nmm67*7REV. /n* <br />