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� - <br /> R OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit Nm <br /> (Complete UnTriplicate) <br /> ------------------------------------- <br /> ' --------- <br /> Date Issued ������ <br /> 1h �m� � '/ � <br /> � <br /> Application is hereby made to the San Joaquin Local HeoUhl)|m,|ct for aper'mit to �rw� and install the work herein <br /> described. This l madecJ with County OrdinanceN549 and existing Rules and Regulations. <br /> Owner's Name ko, -7- <br /> Con�o�o,'allome --. -.-.--_----_-.---------License # ------------------------ Phone --------------------- -------- <br /> Installation will <br /> .--'|nmoUohpnwi|| serve- Res i6enon XApartment Hovmy,[] Commercial C]TroUe,Cmurt 0 ' <br /> kAo*e| F1 Other -------------------------------------------- <br /> Number of living <br /> -----_-----_-_-'Nvm6n, of |iWng vnih``..-/-. Number ofbedrooms -3----Garbage Grn6erLot Size --------- <br /> ---VVWater Supply: <br /> ote, 3upply. Public System and name _---'-'-- ----------------------------------------------------------------' | <br /> Character ofsoil toodepth of3feet: Sand'E] Silt E] Clay E] Pea t E-] SandyLoam -E] Clay-LoamA11 J <br /> ' <br /> Hardpan E] Adobe,[] Fill Material �.---' |fyes,type -__------.-- � _ / <br /> �� <br /> (plot plan' showing size of lot, location of system in relation to- wells, 6ui|cUnQs' etc. must be placed on reverse side.) SO <br />� NEW ; (No septic tank or seepage pit pe6itted if public sewer isavailable within 200 feetj <br /> � <br /> PACKAGE TREATMENT � <br /> `I SEPTIC TANK ] .".�-. Liquid Depth <br /> ' ���� <br /> Capacity ^����!J�!_ Type �c*c'�'��^.� Mmhmr|ol No. Compartments <br /> Distance to nno,00* Well <br /> ---. - --Foundation^�--------' Pnxp. Line ---...��.-'� - <br /> BACH|NG UNE of Length of '— <br /> � <br /> ^ ~ 'D' Box Depth Filter Nka��o| --.���---------------------- <br /> Distance <br /> -_. ---- / <br /> Type ' -- ---- / '� —' ' <br /> Di�oncetoneaestVVe | - --' Foundation ���.----.- Property L�� ^��._- <br /> ------------ <br /> SEEPAGE �T Depth --- - Diameter �^�' -' Number;-. -�' ' ' �nck Filled Yes �� No <br /> ------ �� - , — ~� . <br /> V�o�r Table Depth ------�&��J�--,---'_'--.--�oc� 3ba -..=�.26---'---- / <br /> '-------------- <br /> Distance to nearest. Well --'—_'_'--'_'-_-Foun6otion --------------------- Prop. Line ...................... <br /> (Prev. Sanitation Pnrmh# -------------------------------------------- Date .-_'--_-_--'_) � <br /> � . <br /> 8optic Tank (Specify Requirements) ------------''_-'-------'—'--'—'_--'-,-'----'_-------_\ -' ! <br /> ~ , . <br /> DisposalField (Specify Requirements) ---------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------- ---'-----'---'----'--'-''-- <br /> ---_-----_—.-----__—_-'—_--'_-_--_- ._.-'___-----_----.---_-- � <br /> _(Dnzvvexichngond ,equiredo6dNpnonreverse side) <br /> | hereby certify that U have prepared this mppMmntimm and that the work will be done in accordance with Saw Jwaqmlm <br /> County Ordinances, State Laws, and Rmymm and Regulations ofthe San Joaquin Local Health District. Home owner or Uiuem+ � <br /> ed � �|� h following:^ f� � � <br /> ' <br /> certi <br /> rti <br /> as to bec jrn ubject to Work <br />� <br /> By '' /� ^---] Title <br /> (if other than owner) <br /> §�R DEPARTMENT USE ONLY ot <br /> APPLICATION ACCEPTED -��- --'-- --.--_- <br /> ---------- ---------------------'---__'---__-'--__-_-�------..�- ----_----.-----. . <br /> `,`°°...`°NA^ CO°"°"".S —' / <br /> � ��--------------------------- � � <br /> ------------------ <br /> ---------- <br /> ------- ----- -----'--------'-----------------' � <br /> .--_--'--__---`.-��--_-'.-___-'—�=----_-__.--'_ ------- <br /> --------------- ^ <br /> � __ _ <br /> -- —'--'--� '—'—'---�------==' ------------ _-.. . <br /> 3AN ]OAQU|N LOCAL HEALTH DISTRICT �r <br /> - EH. 9 1''68 Ray. 5N\ <br />