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FOR OFFICE USE AMOMATION FOR SANITATION PERMIT !� <br /> ICemplsfe In TriplitoW3 Permit No. <br /> ^ This Parnrlt E:phtes I Year Frew Date Issued Dote Issued /A ""X617 <br /> Appliratiots is hereby mock M the Son Joaquin Local Health District for a Perini. to construct and install the work luetin <br /> described This applicolion Is made in compflarsce wish County Ordinance No. SA9 and esistipg Rules and Regulations. <br /> 109 ADDRESSAOCATtIsON t�(Prr//0�� YJ/ w� /�.!/,. / CENSUS TRACT 514 7 <br /> Owner's Nome �l ..el .fn,r ..... /lO •. ... .... . . Phone <br /> Address P U '^V // 0. City ..(. Wis A-44 ... .. ' <br /> Contractor s Name 'r� . . License A Phone ... o <br /> Insfailat,on will save. Resbderict)&Apartment House Q Conmerciol LnTrailer Court <br /> Motel M O her <br /> Number of living units Number of bedrooms vT . .Garbage Grinder Lot$ize Av-"'04— <br /> Water Supply Public System and nome • Private-, <br /> Cho-artar o? sail fo a dtPrh of 3 feet: Sand)'_`h Sitt(] Gay &j Plot?'j Sandy loam ❑ Coy Loom Ll s <br /> Hordpan Adobe C fill MMeriel 14 yes,type _ <br /> [Plot p'on. showing sue of lar, location of system In rotation to wells, buildings, etc. must be placed an reverse side.l <br /> NEW INSTALLATION: INo septic tank or seepage pit permiited if Public sewer .t available within 200 faet,l <br /> PACKAGETREATMENT ! I SEPTIC TANK / SS" , . �i t s- y Liquid Depth y <br /> Capacity „♦'�^� TypefrwY !V Allaterial `.,r'vvr+�Arri No, tompotimettts r .' ..... .. 1`4 <br /> D stance •a nearest Wolf f!-+rf/' foundation d . . Prop. Line yr '4 4 <br /> LEACHING LINE [ ; No of Lines .7_ Length of line /." 70101 Length .2-.0 <br /> D' Bos /. .44A&Itype Filter Material . Depth Filter Material /7 - <br /> D.tfance to nearest- Well /IJ-VU Foundation ry©O Property Line <br /> SEEPAGE PIT Depth A`r Diameter J^.3. ' Nvmbe• .�- r Rock Filled Yes (� No 0 <br /> S <br /> 'Norio. Table Depth .f aro _�. Rack Size At <br /> O�sta-rat rp nea•et+: Well /Q"r,!'!1' . ..Fovndmon /6"0 Prop, line tit '...4 <br /> RVAIVADD1TI100iliPrev. Sanitation Permit I Dat _ J <br /> Septic Tank (Specify Regv:ramen'sl - <br /> D,spos0l Fiats {Specify Ragvireniantf) <br /> (Draw exv ng and rertu.red addition on revers- sidel <br /> 1 hereby certify that 1 have prepared this application and that the work will be done in oceerdeace with Sen Joaquin <br /> County Ordinances, Sate Laws, and Rvles and Regvlotiens of the San Jeagoin local Health 0764,kt. Hemet owner or fictn- <br /> sed agents signature certifies rise f91lowln97 <br /> "I certify that in rhe performance of the war* for which IN, Permit is +ssusd, 1 shall not ampley any person in wc)% moi rater <br /> as to become(((yyy///ppPblo to WOA+/n opn*$ Compensation laws of Coldernla." <br /> 5,9rerl :7,. wlf Y ^ "�, Owner <br /> By (�f _` (� Iifle <br /> df orFeO .Fan owner; <br /> islr FOR DtPARTAWNT U311 ONLY <br /> APPLICATION ACCEPTED 9Y .. . r1160401. DATE <br /> BUILDING PERMIT ISSUED DATE . <br /> ADDITIONAL COMMENTS <br /> ... . .. <br /> r <br /> Fir-ofInsptcsien by: +^^j-s�f�t..Gc1 Date � `A'W '.7O <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E N. 9 1=66 Rev- SM, <br />