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OR OFFICE USE:
<br />FOR OFFICE USE:
<br />APPLICATION FOR SANITATION PERMIT
<br />Permit No..77�7-/,V.7�
<br />lComPI#t* IqjAplicaft) Date I Issuedl.
<br />...... _ ....... This Permit Expires I Year From Date Issued
<br />I
<br />he,, - 11 pe
<br />Application is hereby made to the rmit to construct and install the work herein described.
<br />4
<br />This application is mode in compliance with County Ordinonc; No. 5!Z;Wxisting Rules aiiij. Regulations=
<br />JOB ADDRESS/ LOCATION.. -�vAeO.LM.,,
<br />Owner's Name. ...Zft 01---.: W,410104.�� ...... ........... ..._.....Phone__ .........
<br />711,
<br />Address. ... .............. City-- .......... ... ..... :-Zip- .7 .................. ......
<br />Contractor's Name. -....i. T.." .... License #.1 ... Ph one. 0�
<br />.10
<br />Installation will serve: ResidencIC3. Apartment House [3 ComimerciolE] Trailer Court ❑
<br />Motel ❑ Other. ..........
<br />.....................
<br />.... Garbage Grinje(,�.Lot'i Size ... ..... ... ..... . ........
<br />Number of living units:...._.-, ,Number of be:droorns,# I i
<br />m I ...... 11 ....... 'Private
<br />Water Supply: Public System and name ... - ........ --- - ----
<br />Character of soil to a dept Clay LoornPT
<br />A�SlFjt aq
<br />peat [I Sandy Loam h of 3 feed...,, 0I
<br />I 'C,, , Fi Mot6rrdF7.-tfyeS,'1*Pe ............ !
<br />H�-rdl5V []'"`"Adobe r_, �y ......
<br />.. .. . .....
<br />St. be arse side,) !Plot pion, sh;wing size of lot, location of system in relation to wells, buil�jnes,et . _laced on rev
<br />�11 - . ta - . �'. -ft. J. �
<br />page pit permitted if public'- ithiA260 feet,) NEW IN.STALLATION't tNa, septit, tank or see sj��er is available X@�
<br />C TANK' I I Sire.-. -1 ...... ...-Liquid Depth,*
<br />GE TREATMEN - P
<br />PACKAGE IT -,111- SEPTI' X..
<br />..... .No, Comportments -'51k, . ..........
<br />c!r- . ..... Motawiol.C4*.74
<br />ro Line.-
<br />P
<br />-r T7tr nce nearest,
<br />L5ngth-110
<br />LEACHING -LINE f] No .of Lin ....... of each ........ Total ..............
<br />Lines._..:.,....__ e
<br />.— "1yip Fil►ffir crteria .1
<br />...... ............... -40
<br />Distanceto nearest. Well.-.....! ...... y2jj_foundotion...,�� ..... .Property ......
<br />Yes No 0
<br />Rock Filled
<br />Size, -
<br />Water Table Depth...._...` ....... -....
<br />SEEPAGE PIT Delh:. .. ... wwn,ber
<br />---- - -------------
<br />Prop. Line .. . .................
<br />DiSt6h r;eoreit: Wei ......
<br />" 0 - �ep
<br />REPAIR/ADDITION jPrev. slnitotion Permit ...........
<br />Septic Tank (Specify equirements)...... ...... ...... ... ............... _,.,.._..».._-._,».,....___._...-_.._........_.,_
<br />..
<br />Disposal Field (Spec
<br />ie Requirements)..-.-. ...... ...... . . . ................. � ... ....... ......... ...._._».._......
<br />...................... ................I......... ........_..•,._..............._.... ............ . . ........
<br />.......... ........... ............. . ... ......__.....«....._.'.-..-....•... .........
<br />t (b ave ;xIstling and required addition on reverie side)
<br />f I
<br />I hereby certify that I have Prepared -this;application and -that the work will " done In accordance with Son Joaquin, County
<br />I Act. Home owner or licensed agents
<br />Ordi ' nm; -State - Usws; 6d Rules and Regulations ef, the Son Joaquin Local Hecith o1st
<br />no
<br />;A -i'
<br />�Pof the work for issued, I SWI not employ arry person in �Vth nnw as
<br />iertify1h6t in the parforman which this permit Is I
<br />to become subject to Workman's Compensation. laws of Califomic-7.
<br />Signed .....Owner
<br />Title. .... ....... - --- .......
<br />ot4i
<br />,thahn'ow
<br />'folk DePARTMlIM USE ONLY
<br />DATE. ... ...;5
<br />APPLICATION ACCEPTED.................
<br /> ....... ---DATE.---- - ....... -
<br />.... ....
<br />DIVISION OF LAND NUMBER ...... . ... .........
<br />ADDITIONALCOMMENTS.... ... . _ .....-.,..........».. ,................... ....... ........... ............................ ........... . . ..... . ...................
<br />............. .............. ........... . .... ........ . .... ........ _..._..._...».....
<br />. . .... ...... . ........... . .......... ........ .......................
<br />................
<br />...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
<br />...... ............ vt . . .
<br />. . . . . . . . . . . . . . . . . . . . -
<br />j . . ........ .......
<br />Final Inspection by;.=� ..... ov. V7,6 a
<br />EM 13 24 SAN J IN L L HEALTH DISTRICT
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