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FOR Ot rv'-E USES <br /> APPLICATION FOR SA41TATION PERMIT V�/O <br /> Permit No. 77-..'sT. ` <br /> (Coer•olete,Ir rlicate) Issued � <br /> Doth Issued 1-17. <br /> This permit Expires 1 Yoor From Dot*Issued <br /> - syj >K OIG ,IiD1GAwilek� me AoiAM� 77'4— <br /> ilip <br /> •ie to the Sor. Joaquin Local Health District for apermit to cons and install the work herein described. <br /> on cor�plignce with County Ordinance No. 549 and existing Rules and Regulationsr <br /> '!ON <br /> G / "o 11 /tI CENSUS TRACT_.D,6 .......... ... <br /> Phos• <br /> suet`. /4 f�PLJPr CityX?,>0 J Zip................... ......... <br /> ..license # /�OrRIZ....PhorM.........�`................. <br /> M ve Residence❑ Apartment House 4O�t'nercia10 R�railer Court ❑ , <br /> Mote Other - <br /> � <br /> Fitts: <br /> ts: � Number of bedrooms _I.. Garbage Grinder .Lat Sits .....4VI 83 <br /> r'•c System and name .._- ._... .................................. ...... <br /> h <br /> Clay Loom <br /> :o a depth of 3 feet: Sand [I Silt❑ Clay[3 peat E Peat❑ ootrX y t <br /> Hardpan ❑ Adobe❑ Fill Material.. ...... If yes,type .. ........................1 <br /> - A <br /> e of lot location of system in relation to wells,buildings,etc.must be placed on mvem side.l +•r� 'i <br /> ,a s z Y <br /> t ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 fee.) �' �•? r <br /> -- liquid Depth.- <br /> '-1TMENT ( J SEPTIC TANK ( J <br /> - Type©it ' <br /> � CCNo. Compafrtenis r <br /> iCapacity <br /> Well �5 .Foundation....�to-1........Prop. une....' rte........»r� <br /> Distance to neares': � • �•-- ••, � <br /> TO................tatal length /.. J <br /> ( J No. a: Lines LengtF� f each line �IN ,y�y».. <br /> sRiacltt ..........».. _t................. <br /> D' Box / Type Filer Materiallq*4C Depth Filter Material............/.. O <br /> Distance to nearest:Well <br /> Foundation . P"13peN Line................................... <br /> t• ( j $epth Diew►eter Ree1w#iM�i■"Q. No OM <br /> :F -� ........., P".uno_•--__�►f'�}. . ."• <br /> 0 C <br /> ADDITION (Prev. Sanitation Permit# ; OoN <br /> nk (Specify Requirements) ' _ .............. <br /> .. ............................. . ................. _ <br /> ......... ................. <br /> nl Feld (Sp�+fY Requirernenl's) ""."'...... <br /> - <br /> .......... .. .. ....._............................................ <br /> (Draw existing and required addition on revMN sklel County <br /> ty certify that t hove prepared this application and that the wwk will be dam In GicMdesteo vA* Son Joaquin <br /> rrces, State Laws, and Rules and Regulations of the San levgain local tfoelth Dismal. Newte owner or Nconsesl alerts <br /> ure ce-hfies the following: Iw sea manner as <br /> ify that in the performance of the work fav which this permit is issued. 1 shell net employ arty per"" <br />:orr suhj t to Workman's Cpmpen aws of California-" <br /> Owner <br /> Tale OlrsY/L� <br /> (If other than owner) <br /> _PO EPARTMW4T USI ONLY -- - <br /> DATE 6 9s <br /> ACCEPTED BY e _ DAT,_ <br /> r LAND NUMBER <br /> COMMENTS <br /> rr76 sM <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />