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FOR OFFICE USE: APP'LICATiON FOR SANITATION PERMITPermit No. <br /> ......................................................... <br /> tCen+pl�h(n Triplicohl - <br /> ......................................... ............... Daft Issued. 7G <br /> This Permit Expires I Yew IF Osteo 11"ved <br /> Applicction is hereby made to the San Joaquin local Health District for a permit to construct and Install the work 11w <br /> is described. This application is made in compliance with County Ordinance No. 549 onj existing Rules and Regulatlostsr <br /> ` n C� '��X1 '1 F... �_.. > !ifcP".� G� <br /> 1 JOB AD[ RESS/LOCATION yi�Il�,�_.....�.............�. <br /> 3 / �.`.. <br /> Owner's Name SLG-�...J..f...../.-�?1.� �.... J 4.1...���. PFtorM - <br /> _ �� <br /> Ao'ress ................. .............................. ... ...._city <br /> ' Contractor's Name............................................_...................... <br /> _....-. <br /> _..Liornse* ...............� Phor+e ... ._.... .... <br /> Installation will serve: Residence14Aportmertt House Commercial❑Trailer Court 0 .; <br /> t Motel❑OtI W......................................-... <br /> !dumb•: of living units,.../...... Number of bedrooms _ ..._._.C+arbage Grinder ............ Lot Size .�ce r <br /> Prfvata)� <br /> NlraM-Supply: Public System and nameLomrx <br /> .._..___.._....__..--..................... , <br /> •" Character of soil to a depth of 3 feet: Sand l] Silt❑ Clay [:] Peat❑ Sandy Loam❑ Clay <br /> Hardpan fl Adobe❑ Fill MaWIal............if yes,type . .. .. .... ....... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on averse -� <br /> ' NEW INSTAII.P.AON• (No septic tank cs seepage pit permitted if public sewer is avoiloble within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK{ j ••_---__12 - ••----••---............ - <br /> Px 1 s fcYrSSizt .'Q� Liquid Depth 9 <br /> capacity ................... Type <br /> µaterial...-.............._. No. Comportmertts <br /> rjo <br /> Distance to nearest Well Llrte - <br /> Foundation..................._. op- <br /> :�� LEACHING UNE [ j No. of tiLines ..._......._ l.err3th of each�Ilse....#41-*............. Total length� 'D' Box : <br />