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FOR OF...C.. i. APPLICATION FOR SANITATION PERMIT <br /> ....,...,.,.....:... . ......,..:............ ... Permit No 7 0� _ <br /> )complete in Triplicate) ....... ............ <br />' •�•.•.••.......•............. This Permit Ex Ins >I Year learn Oak hswd Date Issued... <br /> Application Is hereby made to the San Joaquin local Health District for a permit to cortistrucf and install the wok bw4a <br /> described. this applicatiowis made in compliance with - unty Ordinance No. 549 and existing Rules and Regulattem <br /> JOB ADDRESS/LOCATIO� N .�,�� .Y. .,.. :....... ... ...... .....................................CENSUS TRACT......................,,.., <br /> Owner's Name ....LUGr.WA....... .................. .....:... ..: ...:.:.......: .. ......: 6 � <br /> /�.. ..._ <br /> [. . fy[f�.....!/ ........i. ....'.........a....l 7•. •.e ..... ., .... w. <br /> r.r. ........ ......r........ .r. ...�....�...Ta/•.......if A....'.....r...w/ <br /> .................. �/ r ............ r <br /> Contractor's Nanr3s ... :i:..... ...... .:. .: . ). Phone 7.7 7 . <br /> ..... .... .........w.....Nw.w........w •... .7 <br /> Installation will serve: Residence O-A�artmenf"W"D Canister CPWOWCVM Q <br /> Motel❑Otho... <br /> Number of living units:... -Number of bedroom ......... lM ilns <br /> ..ww. Qfhl .... ww.... .w <br /> Water Supply, Public System and name ......�. y......r.._.N •w........wN..Mit.w.Ni.Mw...M..N.NNN.w...w.N..ww Q. <br /> Character of soil too depth of 3 frit, SandE3 Silt Q CloyQ half Q fanAr Lorin C3C�ksy Loam�' <br /> Hardpan C3 adobe Q /M Will f1i1............M . <br /> IMot plan, showirs9 44e of lot, location of system in MkAm M WIfti dNt9i, alc. WAW be plocul an t*om dW <br /> IM1!!1 MWALLATIONt (No septic tank or seepage pit peret111ed it l rwNr Ale w1lhltt 200 fart,! <br /> PACKAGE TREATMENT d ) SEPTIC TAMC �.. �..... ��, tiquld Drpth . ...1,l.....�`.N..:.... , <br /> ' " . w......, <br /> Carty � ..C? ...... Type t�::�.� . <br /> Distance.to nearest: Well 1A.4) .Nue.. f CYC <br /> IrwntifiNrw. <br /> WICHING EINE No. of lines 3..... ; Leiglis a! Nrw. ,... ... fe1a1 Let+ptlt r. Z. 3 ..�. r <br /> '11' Bax ! T filter Ma eria <br /> Yip t ... 1 Mstlrrid ......1. ......... <br /> .. <br /> •:IlELPA Distance to nearests Well ,1�C1............. <br /> 1�aystdiitltMn .�/..C��.......... Property LMta...... ....�.�..... <br /> PIT ( # Depth .....:......... ... Dlcirneter .. ...;...:. Nersiber ... ............:....... geode Filled Y" 13 0010 - <br /> Water <br /> 0QWater Table Depth ..................4...........................«l lllrf ..:::....................... <br /> :.:. . <br /> Distance to nearest: well ............. ........::N.. ..................... Prop. LIM ............. <br /> NPA1!/4DDITION(Prov. Sanitation Permit sP ............................................... 111M <br /> Septic Tank (Specify Requlretttents)....:............... .............»......... <br /> .............w:...N.:..w:..:............................................:........w.:.:.:-- <br /> Disposal Field (Specify Requirements) ...................... ............w.............:....:............:...........:..........::..: ....:......:.....:...:........:.:. <br /> ...r.....r <br /> ............................................................................................................................:.......................u............«..:...:„w::.w....... <br /> N...... <br /> ... (Draw existing d required Adltion an lnswse sid�`•••••••u..u.u. ........w.wo.u... <br /> an <br /> I hereby certify that I have prepared this application and that 110 ”" wM be dow In "cordance with Sm �w % <br /> County Ordinances, State laws, and Rules and Regulations of the S" de"Wks teuel Neplgt,District.Hama e>tater 4it�Ei• <br /> sed.agents signature certifies the following: <br /> "I certify that in the performance of the work for which this p*"n%Is Iss>rsd,1 s11 PW employ any persen M so&mir <br /> as.to become Wec to War an's Co pensatlon laws of CaWera%" <br /> Signed <br /> By ..............•--- ... : ..-- ...... ........ . J;tf �... .:.........:.......: <br /> IIf other owner) <br /> FOR DEPARTMENT USE O Y <br /> APPLICATION ACCEPTED BY .... .... ..... DATE .. � <br /> BUILDING PERMIT ISSUED ................................................... ......................DATE ---..-..................................... <br /> ADDITIONALCOMMENTS .................................................. .................................. <br /> ......:............... ................,.... <br /> Final Inspection by: ......... ......... ......... <br /> 3 2!� 1-6I3....11ov -- .......................................Date .....��-...._dd <br /> .. <br /> • SAN JOA- LOC EALTH DISTRICT 8/74 3M <br />