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C <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ...................... <br /> (Complete in Tripiic�te) Permit No_....._'. .. . .. <br /> Date lssuecl' .�' Y- �J <br /> .......... <br />{ <br /> �"t ... .. ... ........... This Permit Expires 1 Year Fram Date Issued <br /> Application is hereby made to.the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Z5 J <br /> JOS ADDRESS/LOC TION ._ ... U_----�r`-�. - .r ------CENSUS TRACT <br /> Owner's N me .__ <br /> a � �1!!�:-._.. .... `'s.. Rhone <br /> Address.----- ----- �. - <br /> r <br /> -- --- ............Cit � ....Zip <br /> --- <br /> ContractormPhone <br /> Installation will serve: Residence 1< Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other, ,. <br /> Number of living units:.._.. 1.... .Number of bedrooms....�2_.Garbage Grinder..-....Ldt Size................. <br /> Water Supply. Public System and name--- -------- y =I --------------------Private <br /> Character of soil to a depth of.3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam [] Clay Loam ❑ <br /> Y Hardpan ❑ Adobe Fill Material.. ._. If yes, type_...._..(_Z <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.[ <br /> NEW INSTALLATION: <br /> (No septic tank or seepage pit permitted..if.pieblic mower is?vailable within 200-feet,) <br /> PACKAGE TREATMENT [ j SEPTIC TANKSize .... f J ` '` ' <br /> [ j > 1. - _. Liquid Depth. T .. <br /> Capacity.�� --------Typ / -(� aterial. C�� :No) Compartments-.•--. ------ - <br /> f i <br /> ,. Distance to nearest: Well-------- . .................:......Foundation- .::., ------------Prop. Line-. ------- <br /> LEACHING LINE <br /> [ ] No. of Lines ... . ...... Length of•each;4jna = <br />