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FOR OFFICE USE. � <br /> APPLICATION FOR SANITATION PERMIT <br /> /~ <br /> �/��/��� 40 xe , �� Permit No. ���x���� <br /> / � ^ {Cwmmpye�,lmT�pX|wm�� '' <br /> Dote |,mond <br /> Th I s.Perm it Expi res 1 Year From Date Issued - r <br /> ---------------- <br /> hereby made to the Sun Joaquin Local Health District for o permit to construct and |nmmU the work herein <br /> described. This || t| is 6 in compliancewith County Or6|nunce No549 and existing Rules and Regulations. . <br /> Jou ADDRESS/LOCATION � <br /> Contractor's Name A-1-0-6;11 t5 ------License # Phone <br /> Installation will serve: Res|6*nce)�f/\portment House-[] Commercial,E]T,oi|e,[po,t C] <br /> kxm*e| []Other ------------------------------------------ <br /> Number <br /> -----.--------Num6*r of living unim`' 9- Number ;�-----Garbagenl`r ----- Lct S[ze --------------- <br /> Vuo«er Supply. PublicSyoovm and nam ---_-..J^ --------------------------------------Private [] <br /> Character of to o6epth of3feet: ��.'E] /Silt[] Clay 0 Peat E] �n6yL�m � Clay-Loam D ' <br /> | ^ <br /> � . El Adobe Fill Nksh»ho/ ------------ If yes, <br /> type ---------------------------- <br /> (Plot <br /> --'__--(Mot plan, showing size -m� <br /> lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)ii <br /> NEW INSTALLATION: (No septic tank o, seepage pit permitted if public oovve, is available within 200 feet) <br /> / <br /> PACKAGE /�7N [ ] SEPTIC TANK ] Size------------------------------------------------ Liquid Depth -----_ ........ <br /> capacity -^ Type --- Material---------------------- No. Compartments -------__-'.-- <br /> 'Dsto' meWell Foundation ---------------------- Prop. Line ---- <br /> LEACHING LINE`/ No. 6f,41,ines ------------------------ Length of each ||ne--------.-' Total Length ------___ <br /> | D' Box ------ Type Filter Material ---'_.---Dopth Filter Material .----_.--.-_------_' <br /> ' <br /> . ,Di*once4to nearest: Well --------- Foundation ------------------------ Property Line, ----__'�-' <br /> SEEPAGE P|T [ ] Deo�6 ����----' Diameter -__'_ Number ------------------ --------- Rock Filled Yew [] No C] ' <br /> ------_---_ . � . <br /> VVoten To6|o Depth ----------- ----_---.--Rock Size -.-----____- <br /> Distance�to nearest. U <br /> � Foundation ' Prop. U <br /> . - / <br /> /L <br /> A_ " _r <br /> yp <br /> . (Specify Requirements) - + <br /> ___ ___ ^ / <br /> /1 -__r_7-__ ��_____.. � <br /> ' hereby~ certify that ~ '^~~~ »~~r~'~~ this ~rp^c~'~~ and that the ^~~ will ~~\~~~~ in accordance with ~~~ Joaquin ' <br /> County Ordinances, State Laws, and Rules and Regulations of the Sal Joaquin Local Health District. Home owner or licen- <br /> _- -=_- -=-__- ` <br /> "I certify that in the performan of th ork for which this permit is issued, I shall not employ any pdrson in such manner <br /> � <br /> as - ---- ' <br /> Signed <br /> // - - , . <br /> (if other than owner) <br /> FOR <br /> °rruCA/"Om *CCcr/cu BY ~�,���� c�"°v�-���� ' <br /> ------- -----' ------- -- -�m��-'--'-'---'--'--- - - � - --�'- ----'----' <br /> Rno| Ins pecMonby: .�J��^�r%u����--��---'_-_-_.----------.---'__Qote ��-.L------_ <br /> SANJDAQU|N LOCAL HEALTH DISTRICT <br /> ~ �� ^ � <br /> E. H. V 1''68 Rev. 6J�-� *�-~~ �- ~�u' �� . �,�1� `' ' - _ � ' <br />