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~ ' <br /> FOR OFFICE USE: - - , <br /> APPLICATION FOR 'SANITATION PERMIT permnN* <br /> '~~ ^~-~ -' N��mmUmrm�� Tr������ .^ _ � <br /> ' 7V <br /> ~� Dote Issued -------------------- <br /> This Permit Expires 1 Year Date Issued <br /> Application is he�rebyl made to the Son Joaquin Local Health District for a permitand install the workherein <br /> described. This application is made in compliance with County Ordinance.No. 5A9 and existing Rules and Regulations <br /> ~~~ '~--ESS/LOCATION <br /> FF" J <br /> � <br /> ------------- <br /> Owner's Name <br /> ` <br /> � <br /> Address . �--'—.--'----'- . <br /> Licen�� #�����/ �[ Ph�ne 8���-"��!� -7� <br /> Cunmo�or'sNorne —' -- ---- <br /> |nmo||ation will serve: -ii� -- -Residencer9Apartment <br /> - ' f],Commercial ElTra||er Court-C]- <br /> Motel [1Other -------------------------------------------- <br /> Number of <br /> -------'__---Nu. berof living units:!------ /. Number of bedrooms ..o�-.-.Gur6:ge Grinder -�--..I Lot Size --------------------------------------------- <br /> ' <br /> ' Pr�u�a [� <br /> VYote, Suppy. Pu6|��yx�amondmzmo _.—'___�_--''-------'---'--'--'--------' <br /> � ' <br /> Character of soil toodepth of3feet: Sand Silt F] Clay E] Peat Sandy Loam E] Clay Loam-E] <br /> ' k . <br /> Hardpan E] Adobe F1 Fill Material ---- If yes,type -�----.-`--.' <br /> ' <br /> buildings,stem in relation to- wells, � moo be placed on reverse side.) � <br /> - plan, - e of lot, location of <br /> NEW INSTALLATION:UNS?ALLATION' � - septic tank or seepage ph permitted if public sewer is available withn 200 feet)' <br /> PACKAGE TREATMENT '[ ] SEPT|CTANKf ] ; Size- -------------------------- Liquid Depth ----.----- <br /> co paci ty Type ' Materia <br /> ~- ' -- <br /> LEACHING LINE � � .,~ .. Lines. _-.=' of -- <br /> " """ ',p~ Filter^ Material <br /> ------------------------ <br /> '°=`""= '" '="'~~' Well <br />� <br />` -_- ._- . .. ` ^ --,- -------- <br /> ` <br />. ..__ Table Depth_ ----------------------- . <br />' U U <br /> Septic Tank (Specify Requirements)|'� _— <br /> `--` '—/ ------ <br /> °"=~=--.--__----.----..Dispu,n| Field (S. . Requ|rnmen�) '�r�o+exn��/��na��'�- �---- <br /> —.----------'_-''�__'--' <br /> --.------_—.^. . ' ---.------ <br /> --'_—_--'--�:-_-- .. .—.--'- <br /> ` <br /> �-�-----'------ ' ~^°.~'' .�--_----------'_-�_--. <br /> o (Dnzvrex|shng om] required o66i�mx on reverse �6e _ <br /> ^~ ��^ � � �� �� �U �e � � ���m with Son ��Um <br /> | hereby certify H��� Y h�vmpr�pmr�� 0,�sm�nl��Ywnm �v �n� � <br />' <br /> County Ordinances, State Lpvps, mn� ��Ye� �m� ���w6mGoosof the Son Joaquin Local Health DimhH��. Home o*vnwv on mcem- <br /> oedmgeow^ dgnatwre ' fimothefwAwvvng' <br /> "I certify that|nthe pm�onmmnc' wfthe work for which this permit |, issued, Ushall not employ any person in such manner <br />| an to become subject tAhanowner) <br /> ' ' Compensation U' of California."` <br /> Signed --.--.-'- Owner <br /> ------' Title .---------------'------l_--'-�� --- <br /> (if <br /> .\ <br /> (|fcther <br /> \ <br /> ' FOR DEPARTMENT USE ONLY <br /> ' '^ ' ^'~^^~'' ''-'-- '-- -' ------------- ~-- ----------- -- ----- - - " DAT <br /> DATE BU|U}|NQ PERMIT ISSUED --.+----._.-------'_','---^c-.�-_--.----- --------------------------- '---- <br /> AD0T|ONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------- '---'----'—'- <br /> ------------------------------- <br /> --------------------- <br /> —.__—.---.—_--.----_-----''��--_ <br /> ----'-----.-- ---.—.-^,-_-'-----'—. -'-' <br /> � -------.—.------�--_.—.------_—.—.--.--.—'---- -----�--_---.------'-_---' <br /> �--�---'-------� .—.-------'----------_--.—. /���'—'^_' <br /> Rnv| |nvpoc�onby, -..�-_�� ..x����w�°_"�--------_.-`-----`--.-�---Date ------�..�v�.��^`v�-------.- <br /> SAN JOAQU|N LOCALHEAiTH DISTRICT <br /> � <br /> E. H. 9 l''68 Rn" 5M <br /> ^ <br />