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T-1 <br /> s4� <br /> M <br /> FOR OFFICE Uo6 FOR OFFICE USE "c e <br /> APPUCAIION FOR SANITATION PERMIT + <br /> ._...._.._.r_.............._.._.._............. Permit No7e7A -•.• E <br /> (Cempims, in Triplicate) e <br /> ` ....L.-._............................................ Date Issued � a.S'7 . 7. <br /> _.•_,,,•__........................................... This Permit Expires 1 Year hem Dan Issued <br /> .Application is hereby made to the Son Joaquin Local Health District for a permit to construct and,install the work herein ydeseribei� <br /> This ^opllcation is node in compliance with County Ordinance No 549 and existing Rules and Regulations- <br /> t <br /> �.. ......�.N •.• s ....._ .. - <br /> t : JOB ADDRESS/LOCATION..,.. ....�.1�.�--4'O.-.......f�A'�L•A'� R s CENSUS TRACT__� <br /> �G �t ,.. h''. <br /> t <br /> ;Owners Name.... ...C•-r,E...........ti.�ad�.�:R9 ... -. ... .. P��Phane r <br /> . �►• 7p� _._. .. _. I Zip <br /> pr <br /> Address -- 7�.`C.•,� .... . .... .. GJy�, ��( r > . <br /> Contractor's Name -./Qx�. ✓• '��-• ..'^'•• - ..License t11150�i6J�v�.,• ,Phone...._ -s - <br /> .Installation'wil! serve: ' ffesidenm ( Apartment House Commerciai❑ railer Court ❑ <br /> .. . . _ .. ,Motel ❑ Other ... <br /> .._ 1 b{1 <br /> • Number r°living units1 IJumber of bedrooms pS Garbage Gander. Lot Size .. <br /> (- <br /> Watcr Supply: Public System and name..... W.D..0 _.. ....... --- --I �r� tt •*'' <br /> Sand❑ -Silt❑ Cloy❑ Peat <br /> Character of soil to a depth of 3 feet: C1 �ndy LoAtm�(' <br /> _ Hardpan❑ Adobe❑ fall Motorial.... . .....If yes ty�e ...:...; ..... .. i . ;.;, <br /> 0.(Plot plan, showing size of lot, location of system in relation to wells buildings etc musd be placed on reSerse side.) s <br /> c t <br /> NEW INSTALLATION ANo septic tank or seepJge pit permitted tffpubLrsewvr is a'arlobie wifnin <br /> -" PACKAGE TREATMENT i 1 'SEPTIC TANK I 1 Size_ `. {-L !aC:quid Depth <br /> - - _ 1No Co'mpa-/ments <br /> Capacity............' TYpe-- Material:..: .. -- <br /> I <br /> Distance to nearest tN II . :Foundation. I Prap Cine <br /> . <br /> mj <br /> 'g LEACHING LINE I 1 No.,of Lines _- .... Length of each Imo -- Tot Le i <br /> }D' Box------------Ta Niter Material.. -.1Depth Filter Mate.... . L -- S{ <br /> iDistance to nearest Well._-. .. Foundation A'7trr. Property Ltne --- <br /> Ail- <br /> SE '.A -c-l'. e ......Diameter - Number ocrz ..t � ' tFilled Yes❑ <br /> k's;Rdater TaLeDepth .. _- h+r <br /> . ,, <br /> `Distanceto nearest.Wall. ....... - "fo ndanon_ �`,.A � +Pro{{p. line rrc <br /> REPAIR/ADDITION (Prey:Sanitation Prm <br /> ei•# 1 <br /> EP <br /> _Septic Tank,(Specify.Regbirementsl -- >�- <br /> .. � - — <br /> i r <br /> -Disposal Field (Specifyaequuements)"".... ... --- -r � <br /> T . t , f/ <br /> - <br /> .. . .... ... .. ._ .-..... ...... . <br /> t <br /> � <br /> .. ... .. .._...1 - --------------------------------- <br /> (Draw <br /> - ... <br /> (Draw existing and required a:aitionon reverse side) <br /> xi <br /> i <br /> .I hereby certify that'l hWarr <br /> �pparmf this upplica!4an and that the r,ork-w111 be dere in acmrdabu W�eh San Joaqu(n,r a-3+�hr. <br /> jOrdinarem Shen tick and Ruler and Rwulr7ions o1 the San Joaquin Local Health Distrrtt-tforne bwnrx or iareAsci ayw... 1 <br /> .st9itehrn canities H.s/allowing = _ —rL1 a# as <br /> t <br /> : _I eertrf►thaf:Fn tho piiformancs of't4 work for Which this r rtmit is Issued 1 shall "11 ernptay�any p►nob In vuch memo <br /> y ro'bseemo subject �f_ rkm s/.omptnsation laws of CsHfornia <br /> S1 .-__...._ _ _ ...... <br /> .Title. -_-_ -. _y�.. .. <br /> ., f _ <br /> - _ (if other than owner) 1'} <br /> 'r .. .FOR DEPARTMENT USI-':OVLY_ r <br /> /7 / <br /> ......-- ..O/t/. �_. ._:..BATE <br /> APPt-ICATION ACCEPTEq BY--- .. ... .. _ __ _. . . . <br /> DIVISION OF L�.`?D NUIdISER_-------^^•^^^^�t..T::.—.:: :_-........_"....--. .. . .. , <br />