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L <br /> rUK Urri .0 Wt: <br /> L APPLICATION FOR SANITATION PERMIT Permit No. . _l_ <br /> - -------- - -------- <br /> (Complete-in Duplicate) <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> _ This application is made in compliance with County Ordinance No. 549. <br /> r. <br /> JOB ADDRESS AND LOCATION---G /IVIV� -------R-04.0--- At!----- S 77 <br /> Owner's Name--- -�--- £---w47-`4- -, - �` {, �q ------------.. <br /> Address-'--------' - -- - '-- --- ----------- <br /> --1 -----? 'r_Ps--a ----------- '- `--1-------------`----------------------------------- <br /> L Contractor's Name.-- / , :_ )_ . - - -.".------------ ----- <br /> - - ---------------- Phone_ 2 .1 t . .-. <br /> Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> V Number of living units: -I._- Number of bedrooms .Z.-- Number of baths..(----- Lot size -.-' ;A" --------- <br /> Water Supply: Public system ❑ Community system ❑ Private' Depth to Water Table 1ASIft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam K Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_.-------......._ ) No ® New Construction: Yes ❑ No �C FHA/VA: Yes ❑ NoN <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well Distance from foundation.__.____._.__.Material_................__.____._________. -_ <br /> ❑ftft 10SF>< No. of compartments - --Size.----------------. <br /> ------------------ - -.-_-Livid 9 P <br /> deP.th__..._._ _. .-__._.Capacity -ty------ ------- <br /> _ - _ e <br /> Disposal Field: Distance from nearest well_6-CO. <br />