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<br /> APPLICATION FOR SANITATION PERMIT
<br /> per mit No +
<br /> (Complete in Triplicate)
<br /> wDa`
<br /> Yhis Permit Expires I Yeer From gate issued
<br /> 'y �✓, hon i ereb made to the San Joaquin Local Health District ford construct a i in
<br /> pa permit to consstall
<br /> �,t sfriled ?h!s{'b�[ilr�otlonrrs:made in compliance 'vlth Ccvnty Ordlrane No, 549 cnd existing Rvle!I7
<br /> ' �t"Jvvner$ Nc to Z./::.���F.•-�a . �i1.��.�t'�.�.L.�•� .. .... pr rq Ft
<br /> City
<br /> ' �t �• .ae
<br /> _... . .:`.License r►�.� �' ahone a ,
<br /> C07,-Cjc�cr's No,. .!
<br /> ,x Instalicitlon.wfll serve wWi .j.
<br /> c Residence [IT Apartment Hose❑ Cc nrr, af[jT ailpr�sburt $_
<br /> k Motel f_Other.. . .... ..urier of irviNumbe of i;ed,00ms - C arhaoe C nder otSize
<br /> =:i Y y �rivatl
<br /> A i!r 5upply;p ! ' c Svs'e•~ cnd m7me .. . . .
<br /> % : Gar r of soil to,a depth of 3 feet: Sond, 51i+ Clay Feat❑ Sandy Loan[] ��
<br /> , i `krofar° ° mar dpan''[1 Adobe Fill1�1 erlul If yes,type . . s
<br /> r5 va
<br /> {Plot pian chow ng3size { !ot 'ocn ,on of system in relation to wells, buildings etc. must plat r
<br /> i � oo feed r`
<br /> NE1hl'tNSTAL�IATION {No septic tank or seepc'ge pit,permitted if,p bjll sew r a�ailab �`+ ft 4
<br /> ,th eAau' p
<br /> + PACKAGEREA�MENTri PTICTANK(r 'v Size .. v+
<br /> ` C ph )) /�t !
<br /> acit�ilrX-�r(!.. Te pe
<br /> �.':ell
<br /> -:2 fl ai�Qfduyt.v�'2L`./C'v,,�lC Pp
<br /> uteri vC m
<br /> ce,to nearest
<br /> Dlstan 17 £
<br /> es Length of acn nb .../..lj •' Tot " Cerigt�fi5
<br /> .-
<br /> .Dep Fi l
<br /> Matericlx ```���/
<br /> Foundation t a roperty.,lhet//
<br /> r� h e( Material
<br /> a e ',o nearest: rve L. 0 - f
<br /> D
<br /> r..r s�• EEPAGEtP1T i �'
<br /> I
<br /> Ro.
<br /> ,Nu44,
<br /> _ Slze.. ..
<br /> ter T ble Depth
<br /> k k Fa1
<br /> t
<br /> A
<br /> rY Dtance to nearest."fr I -------
<br /> 95 c
<br /> • r
<br /> s
<br /> ey -
<br /> EM IRr'�DD1TI rs' Sanitation'.Permrt# - `lJ
<br /> ' ,,A" '.` �' .. /.� 'I/1 ��° _ ��%'�. '�'� /�-'�y%•.y� ... Y�,Yrisrriuk,��``°�r*�i��;'
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<br /> ,� O i✓ �Q '��,s�!'� moi:d`,.F%Sj�',r4� �/�Y,�" :r .;.� •xr„� ; ,
<br /> a r
<br /> �:•.�f CSI r-.Vers@_�:C1P
<br /> t ,""(Dia v er;,• � ard r= gyred a
<br /> hero erTR thatC;f,hav0prepared this appllcrton and that the work will he dons in'aceardtlnee
<br /> Ceun Ord es, State Lcv,s, and Rules and Reguiatlans o r the ar Joaquin Local Nea:9h C strict, tiom�'
<br /> w, seel,a signature certifies the following!
<br /> es in th'e performance of the work fo' which this permit ,s <ssue-d, I shat t employ an`
<br /> -> •;.
<br /> r� as to eC e'sub•ect to Workwan's Compensation laws of Cahfor a,
<br /> Sign � � Ct1i.'>i�,�'E._ �✓F X��`� ' '�
<br /> t; l{ !iler
<br /> Y
<br /> a FOR DEPAR M.ENT USE ONLY
<br /> v gPP, A110iVACCEPTEDscBY,:
<br /> v^.
<br /> °BUILD)NG �ERMITISSUED � -
<br /> ADDI;T(OINAkC07NAAENTS # 2 5 y._ (� A7,4�( ��ti�'Irnf c'r°: < ,3sXl� a.��.�'�I[ ' t=;•1
<br /> �J y
<br /> s ' SA,I•V�'OAQUI yLOC'AL.�.yEALTH D STRICT
<br /> '1� ��t��* k" ,"c`." LA; �� ��,•SPt� � i.'� w�� r°� » '� Iri � Y...,�,j � i
<br /> $'+ ,� i I R .aY�4 f, a iy,•K� ',��f+�A 1� >i.?.
<br />
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