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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ......:.......: . (CornpraM{nTriplicatel. 7..b..a13 <br /> ............................ This PormitExpires f Tour from Datelsatred. Date Issvad'.3.f� 76 <br /> Application is harebyI�- to the San Joaquin local Health District for -aperniN`tii�strud and Install the work herein <br /> described. This appltcatlon is-made In compliance with County Ordinance No. 549 and existing Rules and Qeguiattonar <br /> 7 <br /> JOB ADDRESSAOCATION ' 6jk Ski <br /> � <br /> r <br /> SLIS <br /> TRACT <br /> + <br /> CE. NOwner's Name r................... <br /> Address' ...../ <br /> Contractor'=Name...:� � .... <br /> t.! -'• ...._. ........license#..{natallation will cve Resiw S <br /> eArQtomnerint <br /> pTrailer[Dort �] <br /> i R <br /> Number Of living units) ...... lot size �-� <br /> Water su { s, Grinder .__ <br /> pp y Public System,ond name <br /> _..�. <br /> Character of&all to a depth-alv <br /> 3>feet Sand•© -SNS Q oY <br /> prQ Y Pea►Q <br /> , . Sasdy!oars p Gap tem"Q <br /> Hardpan Cj Adobe <br /> IPrat plan, showing size of lot, location-of system tn.+alotton to•welis;iwndi � <br /> spa, ata unat be placed on <br /> nYstw <br /> KLW iNST_ Aom;LLATipp_ ft septic tank or seepage pit txtatMbd N <br /> p� sever la otroa"athM 400 tat.! <br /> PACKAGE TREATMENT .[ 1 SEPTIC TAMC{']s' V . 5-r-St. i .7...... <br /> ............... Liquid Depth ... <br /> Ca °k <br /> ` 1 t�+r •• ::.. Typo :: ...... � <br /> Ne comporhrnrMt jj <br /> ( Distance.to nearest well <br /> Fourtdatlen _ Lina Q'I <br /> rEACttJfIGLItJE �" <br /> #[:1 'No, of tines dt of sods line Tatd <br /> hngeh *a <br /> Type filter Material .:.... Depth( Maasriaf `� ' ... & <br /> ....... <br /> j. Distance to nearest' Welt ..... foundation <br /> PAGE PIT ( It Depth l �� r property Lisle". ......... .. <br /> Oianater Number .... ` <br /> REA .} Water Tabic!Depth ..: w Rodr <br /> FRied Yea Q Ira 001 N ` <br /> .._...16odc 5 .. <br /> Otatattca to t serest Wen ' .__Fatmdatlon _ per, <br /> AWADOi M(Prov. Saniiotion"ittP :.. ( / _.. . _. <br /> Data <br /> Septic Tank {Specify Requirernenta) 3 <br /> Dlaposal Heid,(fpedfy Requirements) 4LQ. r -Fc 7r <br /> ii <br /> . .. . . . t.-.15 <br /> '(DrOW existing and required addition on"reverse side!, '�'...�;.. _ p <br /> thereby certify that t have prepared this application and that the wodtlwm hedone in .f <br /> County ordinances; State Laws, and Rules and Ragatations of the San Joaquin IAm1 pk <br /> Hea .DhIr$t,Rome atm orRun- <br /> sod.agents signature certifies the foliowing: t <br /> "I certify that in the performance of the work for which this penatt.b booed, 1 shag set araploy <br /> as to become subject to Workmonht Componsatien laws of Catifarnia." j ( a <br /> J my <br /> pum Is Such Signed ..... ...............'.... .r <br /> Owner . <br /> By..... ...... . .... .` Title ... . ... <br /> (If than ownerl ........................ ..................... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION AC EPTED BY <br /> -----......._ .. . . ..............::........:.......:.:.:.::..... <br /> BUILDING PERMIT ISSUED ............. DATE -5::-:.:'...�.: .-----:-:.:'..:' <br /> ADDITIONAL COM S ........ ...................................................... DATE ._...-:...... .....:.........-..-.:....: <br /> .......................... ............ <br /> _... ..... n �, �... .. ..... <br /> .. .. ....... .: <br /> -;d6-�:�.:: ..... <br /> ......-.-._ .. ..a. ....... .._-... ............. :.............. <br /> !Ins ecrion b '...`....- ...... ...... <br /> p. y: .. .. . .......................................... �j- ..............1.;. <br /> 13 24 1-6{3 .. r . r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT tl/��j 3TR � <br /> r. . <br />