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a r. <br /> 4 <br /> �•� � v-''rJ��'� 4 �� _ � . .� �� fti.��i1�x �F �`r'�' ."a 1r�frti•1 '. <br /> .� FOR OFFICE U56 APPLICATION FOR SANITATION PERMIT <br /> 43 ..."-"... Permit No....».._......_... <br /> .._......... <br /> ,`. ... »_................ .............""......... (Complete In Triplicate. 1. - <br /> _ .T 7S <br /> . ,. . Date Issued � .. <br /> ,., .-..».-......»........................".............. This Permit Expires I Year From Date Issued __ .. d.�•a. <br /> l�Yat L <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrict and inafoli the work IMHin . <br /> v described. This application Is mode in compliance with County Ordinance No. 549 and existing.Rules and Regulatonss; i <br /> _ JOB-ADDRESSAOCATION ,...... '..2r.. Q........... .etA LC ... ..... CENSUS TRACT. .:. ..» . <br /> Owner's Nmme ...... T/. S.qrn-!.............._.......:» _..». .................... Pharr�i� <br /> dGJ <br /> ....j"......... ... ..._.........................._.:». CNy JarT » <br /> Contactor a Name. �i..:G.l. C/.LLL`r" ..........._....-........._" Jy - <br /> ...Llano /� .�Phone <br /> tnsfalatlon will serve: Residence(0 Apartment House Q Commercial QTraller Court a <br /> Motel OOther............"--......................... <br /> Number of living units:_1...... Number of bedrooms -.._r:":".Garbage C!Inder "........... Lot Size ...._........ <br /> Water Supply, Public System and name.-..._..""".. ..: .."P Ovate ,t { <br /> Character of sal to a depth of 3 feet. Sand❑ Silt❑ Clay 0 Peat❑ Sandy loam 1: Clay Loam Q i <br /> Ril Motorial............N <br /> [Piot-plan, ahowiig :lure of lot, looatfon,of syKem-in relation hi wells, buildings, etc. mbar'ba placed on rhrvsrn�fkla-J '' <br /> "KELN tiQSTAliAT10Nr - (No septic.tank or i";,a pit pe'rmltmcl If'publIc sewer Is available within 200 feetJ t„ <br /> PACKAGE TREATMENT [ ] `SEPTIC TANK;] Sizc_...._.."_«:_.--_. . -.. ....«.. ...".. .Liquid Depth .". <br /> - .. Material" ..... Nc Compartments •�`'y <br /> Capadly : ........ ". TYPO ..."...".-•----'- •---. x <br /> + - - Distance to newest: Neil .--.................. ._...FovndaHaa L.prop.Line O n' <br /> "LFACrUNGUNE [ J No. of Uses .................. Length oF,eca line............................ Total Length <br /> 'D' Box Type Filter-Material ._. .._1....Depth Filter Material .. •" <br /> ....... .._.-... ..:r.. <br /> . Distenr to nearest: Weil ... ........... Foundation .................. Properly 1Jr» . --�---Y <br /> ...SEEPAGE PIT Depth ._..::"............ Diameter ....."_"""......'Number ........................... 0.:;Roc <br /> to <br /> ck Filled Yes <br /> iVatei Table Depth .."".-.:... Jwj-.Size._.: i A <br /> s . <br /> i Dlatance to nearest:Well ..............................._ To.ndation .................. Prop. Une ._....._ <br /> 3 REPALR/ADDITION Wrev.Sanitation'Perm4 ils...---....._«----------_--------_".. Date ..._.................. <br /> c ...................._...»_....._._.... ..._. v <br /> ? Septic Tack (,pecify RequfremenOsl ..............t••».".. , - r r -t � <br /> -- Dispwai' l--ald Nedfy Requirements) '.......... <br /> _.._�..�:.: <br /> ...... -:. . ""--- .....................................- _:..... -........ ............... .:.............---- .... <br /> .. . <br /> - ...._. . - ._..._ ._...".:-._...-"."..-" .-.."......-----._.---"---.......-"..".,....".._--ski '----- -...._ ....» .. <br /> ---- -- (Draw existing and required addition on revera) <br /> se.%Isl <br /> : I hereby_a_ rtify tbw I.he"prepasd thls applicaslan and that. the work will nO dono In occomews:with Saw leegole '4, <br /> County Ordinanceo, State Laws, and Rules and Regulations of the San Joaquin Local Hedth.DisMN_Home Owner Or licit- <br /> sod cgenb signature cc llfiss the following: -- '- <br /> W crc!fHy.that in the performance of the work for which this Permit is lssuvl, I %half not empl'ey coy person in tech mOneer <br /> v- Amy,to bocorne�Shblo�,ct/LgN'o man/s�,CS,mpannssa lan les. of California." <br /> Sig -�r------ !/ - .. _. .._ OwrRr <br /> nod ..... <br /> t BY........................................". ....."-....-. """"....--------.-...... Title .._. . ........................... . .. .":.:. . .- . .- <br /> :s <br /> (If other than owned - - - <br /> FPR EPARTMRN7 VJSE•ONLY. <br /> d APPLICATION ACCEPTED BY..... .. ... DATE ,t��7F7,-•.. <br /> �7 _..........................."-..............."._ <br /> BUILDINGPEPJJIIT ISSUED ...................................-----".".."..""......-"----..............-«...."..................DATE....--..........._......._»........_.. ; <br /> -a ADDITiONAt. COMMENTS ................... ........................................."._.............................................................................._._......... ' <br /> - ....._ <br /> ..........................................._......._....-...................................... <br /> ................................."................_...-----__".......... ..,........."............---."........"".."...."................. ...."..............._.....__...:_._......_.... <br /> 3Fnal InsPec ...................."......."............" .... ....Date... <br /> rion _ ."..✓l/-�✓ S <br /> Eli 13 21, 1-68 Rev. _qd SAN JOAQUIN LOCAL HEALTH DISTRICT 8/76 3H <br /> Kt.rv...—.:.,+..«..._"-__•__...._._.._."... _......•. ...»:u«..•...�..�+•---.parr-..,.'•Y a:.vr - � <br />