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FOR OFFICE irSE. <br /> APPLICATION FOR SANITATION PERMIT <br /> ieempleN in Triplicate) Permit No. ./.7'3� <br /> - . This permit Ezpkes 1 Year From Do?*Itseed Dave Issued <br /> Appl,coeron is hereby mode to the Son Joaquin Local Health District for o Permit to construct and instoll the work heroin <br /> deursLed. Th.s OpplKOtion is made in COMPliorlcs with County Ordinance No. 549 apid 9 vulof'ons- <br /> JOB ADDRESS/IOCATiON Y f C U� -C-C;A le ' E CENSUS TRAGI <br /> Owner-* Pam. .Ca -c _ -.. . <br /> Pf+errt <br /> - 7�-!',e .`?'! ! <br /> .w <br /> _ <br /> Address r8 / .. ..mac....... _. c'J..fcity _../_.._:..... ...... <br /> Contractor's Norco . acts�e.a�4 .�- `.tritcw+.s lieens0 r�.1C'Jf'�7 Plum! iFt •! <br /> i lsaetotien will sorvat,— Ra,idener�Apor/menHeuw Q Comawcel OTrdM� •T+gY <br /> esyr <br /> AAaol Q Other .... ..... ............ <br /> ... .. .. . <br /> Number of Luing unite <br /> Nrwmbw of M, <br /> Character <br /> crird..,$LOWSlitr . . .'Q� ' <br /> Water 3uDPIY: Public Syseem nr <br /> and npW '.. . .. si 4� C� ............. . ... ......... private <br /> of soli to o depth of 9 lost: gond Q Silt 0 Clay C7 Peat 0 Sandy team Q Cloy loon#T,rbut <br /> HwdPgn.*- Adobe Q Fill Material . . . .. IF yes, <br /> IP:or plan, showing size of IM. location Of oyster in rNation to WWII*, boikii <br /> ngs, etc, must be placed an reowse i.do.l� ^I <br /> NEW iNSTAWTION IN* *optic ton& or saepogW ph perm)"od I4 public ssww is woibble w,thin Zoo festa V, <br /> PACKAGE TREATMENT : ] SEPTIC TANK �X ._ k� A liquid Depth ....A�r_.... . <br /> Copocrty/Ac-e 4W.TYWMolerial..C�cwe+s, cmmportmulfs ...."�._.,..,.,. <br /> Distance to newest, Wal .at4'..P. . ... ............Foundotiorr,a'lQ.r. Pup- Wit ...J... . <br /> LEACHING UNE No. of Lines N? . Length of each line VPr tad tenpgf <br /> -0- Sam /. Typo Fiber Mot dol WP+a- -Depth Filter MotwW �.� _�.... ........ ..__. <br /> i Distance to newest, Well r�fr:C' .. ., .. Foundation .Zo. .e.. FYopoeFy lYtt - r. <br /> SEEPAGE PIT M Depth .Q'C'r Diameter �]„'�.� Number �. ............ .. Reek Filled Yes (�( No C:t? r <br /> Wever Table Depth............................A m*sue <br /> a Distance to neonase WWII 07C,47.. ..................Alsnrdotten .��--•--- Hep. .._...... <br /> REPAMIADC4"ONIPrev. Sanitation permit# . .... . _-....__._. - __... - cob ................._._..__.._....-) s <br /> Septic Tank (Specify Requirementa) _ ..... _ . . . __.. .. ._ <br /> Disposal Field i <br /> Spac,iY Requiromorrts) <br /> i0row ea,st,ng and required odd-non on reverse side) <br /> I herby certify that I have Prepared (kis OpPlkotien end rho# rho work will be done in accordance with San Joavrin <br /> CeuntY Ordirtontes, State Lows, and Rales and RogubSens of the Son Joaquin Legal Heolth District. Hemp ewnw ar litem <br /> sed agents signature certifies tho following; <br /> -'t Comfy that in the porfermance of rhe web for wkieb this Permit is kw"' 1 awl not ami fey any Person in arch mwtner <br /> I as to became ■vbirct N Worl,men'a Comomposoon table of coniornio." <br /> 5-gned <br /> 1 _... Owner _ <br /> t <br /> [if other than • _:/� .... ..... .. �,+. Jitie ( eC as �r CLLW_ i -r <br /> t FOR DEf•ARTM/NT Will ONLY <br /> APPLICATION ACCEPTED RYDA7E .'S - .. U <br /> MIy <br /> _... <br /> RUaOiKG PERT ISSUED .... . .. <br /> _.._. DATE .... .... ....... <br /> ^^kDDITiONAI COMMENTS . . ........................._ .. ....._-----------....... <br /> Finoi inspection by. . .... ... . . <br /> .. <br /> J(MOUIN1IOCAt HEALTH DISTRICT <br /> E H. 13 24 1.-08 Rev. SM <br />