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4 <br /> FOR OFFIe�lSE; <br /> APPLICATION FOR SANITATION PERMIT -74 , <br /> (Conspleteln T Perm No. <br /> dP�l <br /> ...... �' <br /> . res. ... . ... This Permit Expi1 Year From Date Issued Date Issued t'`_, :�d <br /> plication Is hereby made to the San Joaquin local Health District for a permit to construct acid Install Ow work Imeh <br /> scribed, This application is made in compliance with County Ordinance No. 549 and *As" Rules and Regulationsr <br /> B ADDRESSAOCATI,/OyN� . . ...1Z.�_Q... .........�.:....../�:•N.7C-9 S ENM" <br /> CTRACT <br /> /.:/. <br />✓Hoc's Name ........ 0!........A. L ......... ...........».............,....Phor»I��e��,74�-- <br /> dress .. ..a3. ..�... .....P.R D-0.............W. <br /> ntractor•s Name...CEKI ..1.f.�1.ED............S.E.�.►..... <br /> tallotion will serves ResidtnctPKAportn ant House{]Com" elal Oftlk' XftM13. A <br /> Motel[]Other....�R3.Il!#aS►.. ....... <br /> caber of living units,...l'�..... Number of bedrooms ........._.Garbage Grinder <br /> .. <br /> iter Supply, Public System and name °C�fit Ll f W.,(<'.4''1:611R,..... PtiivoNr❑ <br /> 3racter of soil tc.a depth of 3 feet: Sand d Silt(] Al <br /> Ctolr`;j j :Pw►Q lioam CIoT, Q.`' <br /> r. . <br /> Hardpan❑ Adobe 'Fill <br /> liAattrial �......If %type <br /> .. .... <br /> it plan, showing size of lot, location of system in relation to wells, buildings, oWy ntltt 4* 00"d one avers• *10 <br /> W INSTALLATION- (No septic tank or seepage pit permitted if public sewer is Ovciilaf a wNMrs X0fief l ` <br /> CKAGE TREATMENT ( ] SEPTIC rK j] Sire...».........»»..»..... HLigsdd <br /> r0eplhr <br /> Capacity . Type .................... Motorial». . . Na. Catnp Rwa ».»»..,.......... <br /> Distance to 6arest: :Well .......... .Foundeon 4_'­_Ptep,Lite .»..» <br /> ACHING LINE No. of lines 1 f....:...».. Total LeRtdlls . . , .....»....... <br /> 'D' Box ..A Type Filter-_ <br /> .y.. ..»......� �.�»».. <br /> Distance to nearest: Well .. � .:... .�».L .:....:..» Propertl► Line ......� <br />:PAGE PIT Depth ...... .... Diameter ...13-1- Nuinber �,:,w ,,.....�.,.., IOOdc fiiMd` Yes No Q <br /> Water Table Depth ...............ji.SS ...... .,:..RakSdee ,: <br /> O ......f�iM1da11b11 �s Ltnr»:alp.....:........ <br /> Distance to nearest:Well . N <br /> AIR/ADDITION(Prey. Sanitation Permit#........ ......... ....:... <br /> ptic Tank(Specify Requirements) ........................................f.. <br /> isposal Field (Specify Requirements) ................]A. 7... ..f!'» LX�ISTt. t .».is M �` ►�w..........« 4 <br />.tu...... r..p �r...t.-. ........a».l. airmiRld-odditionryIra ng on rewne sklu)flNZ <br /> refiy"e rtiiji that I have'prepored this application and that the work will 'be'diose In abeerdasee wits.Sms d w , <br /> my Ordinanets, State Laws, and Rules and Reguladees of the Soh Joepdie'tocal 11ertM DM&&Nene,aM►Met'AIF 8011. fi <br /> agents signature osrtifies the following: `` <br /> rtify that In the performance of the work for whith this pomp Is bawd,l then Mot'sop*MyrpMMM IM wilt FAMOK���'' <br /> s becomo subloo to Workman's Compensation laws of Celif n t.� <br /> d ..............»..... Owner <br /> ..... .. W........'»�»..N.M».•M..M..... <br /> pf other than owner) ��� <br /> FOR DEPARTMENT USt� <br /> (CATION ACCEPTED BY. .'r. A... .,..: DATE; , � y�....... � <br /> DING PERMIT ISSUED...... ........................ ....... ... ` <br /> ..�.,.. .DATE ..�..,�..rr.,x«...., ,..x.�.:«..�...w:. � <br /> ITIONAL COMMEP!TS.. . .. .. ,..... +.�. ... ...:�.; .r.+..». ,...:...N....... M b <br /> .Inspection by, ....., <br /> SAN JOAQUIN LOCALS <br /> .w a <br /> y <br /> 9 1-'68 Rev. SM `�' « <br />