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roo OEf'Cr_ ' 'r' APPLICATION FOR SANITATION PERMIT P�,mit No. •7 S S Sr <br /> ICernplete in TrlPllcahl Ooh Issutd 7", . 7 S <br /> TMs Ptrmit Exillres I Year haver D<Na lawn <br /> exlstlnq Rvleto constrvd and Install <br /> mH the work <br /> for No. S,9 and s and R"gvletbnw <br /> Application is hereby made to the Son Joaquin Loco) Health Districto pH <br /> T hfatian Is mode in compliance with County adinanCe <br /> described tete app �G.._ .N CENSUS TRACT (^1 <br /> J70 ADDRESS/LOCAT ON /r� • <br /> Owner's Nome 1 f '`:+ !�:..�... `.,7 t� <br /> Address - - ,l8P3�r.. . f�+on. ...... <br /> -%-.-..• ....�!'.�.. .. -f��.,/..license <br /> Contractor's NameCanrr"MW ovo11"rCourt 0 <br /> installation will serve, Res{derKe❑Apwftn@M <br /> Motel Q Of1w .dye.- •,�..�' r"`..... <br /> Y <br /> .Ciaarbav Grind.. .... Wa <br /> �. <br /> Number of living units .•.._ Nver►b+r of �drooms •'.• •••-• <br /> Water Supply: stem and nom" .................................»..............Poe0..... r` boon+ <br /> I Public Sy Cloy <br /> 511t p cby O <br /> 4 .I to o depth of 3 fort► Sand❑ ` <br /> character o P Hardpan❑ Adobe❑ fill M ... ........If Y"'" <br /> M relation to wells, bwIldings, ere- mwt be Pbad an rat►arM .� <br /> 1 <br /> (Plot plan, showinrt size of lot, location of system seww is wrolloh& App f""ta <br /> wltlrin i <br /> NEW INSTALLATION: (No septic tank a P� PKr^ if pubk otiquild <br /> No <br /> 5. <br /> PACKAG _�� <br /> E TREATMENT ( J SEPTIC TANK ....x• t� » trn"rsls •}�.�... <br /> Capacity 1 .0A......... Type �' .....�� .».r"nX Lha_ 051 <br /> Distance to nearest, Well ........ ...1h of each... <br /> ... ......rr0..�. •- Total Lam* •�E�tvf�/ <br /> LEACHING LINE (� No. of Lines fRh"t � /�-. -•••• <br /> D' Brix ..../ . Type Filter Material -.. <br /> .....Depth SIMM <br /> ***-- <br /> Foundation �l ..-.. .. hop"rh►. ... . <br /> NO <br /> Distance to nearesh W"II ......,5C Rock FITIdd Yb <br /> DlcwrAVW .. ..... Numb"r . ..... Y <br /> Depth .. . �.5 r r <br /> SEEPAGE PIT ( •-••- <br /> Rack Sita../ • -� .. <br /> Water Toblo Depth ............ ,�>�. ....... ......._... �f <br />, { <br /> ....•......_..Foundation •-� .. ftoP• Lin" ....,: •-•»- <br /> Distance to nearest,Well ....../-.Z-- <br /> ti Date ----•- _.».-....._. <br /> Sanitation Permit f <br /> s <br /> Sa •••...._....... . <br /> REPAIR/ADDITION(Prev. ""'•'-•'•--•-••�•--•• <br /> i Requirements) .....-_..... .............. <br /> Septic Tank (Spec fY eQ i <br /> egviremenb) <br /> ........................ <br /> Disposal Field (Specify R ......................... <br /> Y _ .............. . . ... ..o �required addition an rtrrus.nidal..»........................W"b so a <br /> (Draw existing sstflls <br /> rand Mat rise wwk wO � "W of N40W i <br />•� <br /> 1 hereby certify that 1 have P"is Rtills ai tM Sews J9 L W <br /> t_ County Ordinances, Stott Laws, in ova meow <br /> sed agents signawn►certes the <br /> following, for W#dck"as Permit Is {sswd.1 sw Poll sop! y <br /> t° <br /> 4'1 certify that In "he Performance any PM900 <br /> of the work ? <br /> ,,.. <br /> COM sotle lows of CelHerwie <br />`•' as to become subject to Wo►kmem's <br />: Owner <br /> Signed Title { <br /> By (If other than owner) <br /> ( FOR DEPARTMENT USE ONLY <br /> _ ... <br /> APPLICATION ACCEPTED 8Y .. DATE <br /> BUILDING PE.,WT IS::UED <br /> ADDITIO'41\l Co%vmENTS �c . ,� <br /> _ <br /> . ... ..:... .... ..... ........_.......... ... . ..... .. . Date <br /> Pmol inspection by ell 8�7lt <br /> F",1 l.i 21, 1-E�i• lieu. 5t SAN JOAQUIN LOCAL HEALTH DISTRICT <br />