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ay4 <br /> - <br /> V.j <br /> ' FOR OFFICE USE. <br /> <-ti APPLICATION FOR SANITATION PERMIT q <br /> Fs'S ICemplete In Triplicate) <br /> Permit No �5 / <br /> it k 7l' ........................ Date 1:sued �3-.. +7.. ! <br /> xs .. .... This Permit Expfres 1 Yaar From Date Issr+ed n ' <br /> pp hereby made to the San Joaquin local Health District for a permit to construct and instal#"The-w In <br /> d described This application is made in compliance with County Ordinance Ngo. 5/49 dad existing Rulas and RepulationsY ;, <br /> JOB ADDRESS/LOCATION -���13....Sr 11'T/Q,. .../�- .... CENSUS T,4ACT S� <br /> '�` Owner s Name ........-. ..... Pho�te <br /> Addrea: ' .. .... ..- . :-.. .......:. city <br /> w� <br /> i `z Contract :Norte './Cl,..�.:. t%�6r�• ..-•---..... ..license ss Phone A. <br /> 3�F ;Insrailwi n will servo Residence <br /> '.L;.r yen Dose fl Commercial []Troller Court;: <br /> Mott i❑ thr f ..................::. <br /> - ._ <br /> ffUvtng uitiYts6 Number of bedrooms ._...Garbcge Grinder Lot Siz�F� <br /> t .�. <br /> 4 Wat Su pylPublre S' t' name and G <br /> .. _ . <br /> �,Yattr of soil to a depth of 3 feet: Sand[j Silt Clay.❑ Ptat[� Sandy Loam Q Cicy <br /> Hardpan t] Adobe F€II Materials yes,type. <br /> iA {Pot plan, sl-owm4} size ot.lot; locotlon of.system in relation to wells Q s.; tt must'ba placed ort reversed=ldll`r`: <br /> i a f �.} = '� R ,. ,4a3.-•S k J {t,s�3, 3 : <br /> NEVllid� CL.r,TiUFt [No septic tanlCto� seepage pit permitted if public s r s aiio6iewithin200 feet,) ,zsi ,+^� .: <br /> r PAC G rE R, hIFN�. SEPTIC TANK( ] Size ...... Liquid depth r i r NNW <br /> pG) = <br /> t a r pacify ���^�,Type - Material ..: No CampaRmants { f; + <br /> ani5e:ta..ae6r-esf,,)Well FoundaN Prop <br /> LEA IN LIN [ ) no of Lrnes ength of each fine Total length a � isfth <br /> r D x ,�; T�peilter tenal Depth Fit r' aterial ,,�5 <br /> ,r D€st oceYto naoreseii Foundation Properly; <br /> y <br /> SEE GE', ITx� J �� Depth Diamete Number J > Rock Filled�`Y Opti No Q;P <br /> x;eq'ef. a r W moble-Depth Ratic Sixes E1� fT •, 1 <br /> AF ; ; DYs once€;to nearest. Weil Faunda /: Prop L#ne <br /> REP IRjA DITI rev' Yta'tid Permit Date t „, 4 <br /> � 4t ryc nk ltequYrenients! .. ¢ ' . <br /> f'`Jr Yl' i �151Y t,. ...... y ..� / .• : 35 E <br /> � D pas q F€e tf5�fy Lirements} <br /> ..... ...... ......... ..... ....... .:...... ... <br /> {Draw existing and required addition on reverse-siIal <br /> lty} <br /> I he tsy rtify that ' h vt r6par+d this`application and risaf:the work will''be in ace erdanci wl SatJeagssiss <br /> l'3 Lk T - . {' - ,.Y'• i c1 <br /> Cou ty 0' fey �e ,'and Rulis and Regulatlons of the Son Joaquin Lo, ea11 DI.Md- Near• er arZ,IkM at <br /> s sad' geh signature ly tllr</o#lowing ;, t n, a r S : <br /> "I s fya Ft in fire a once Of the work for which th#s.gsiraslt,ls issued, I skal nOVOMP#oy'any:person i SM <br /> elf <br /> r as b o e sub ee s t ensalion laws of+Cailiornia. 1 s.1 fir. <br /> MiGs rA.r � ,- <br /> y Sign GG�r i Owner <br /> „r X r L <br /> airie t <br /> ' t- (If other than owner) r ' <br /> !; FOR DEPARTMENT USE ONiLY <br /> Mie Y.. . > �.�.• _. <br /> '1L' .' .. <br /> Mx APP Y N ACCf:PTED BY O DATE <br /> Bli <br /> iING' ERMITs;JSSUED" :_."DAT <br /> E r <br /> AD TION L COMMENTS Aka <br /> N�'} } i <br /> `� <br /> K tiSAN 10AQUIN LOCAL HEALTH' <br /> <13 241 68 Rev.'SM isl,1 <br /> E.=H. 7/72 3?. <br />