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' <br /> FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT <br /> Permit Nu` -----� �-' <br /> -----«�y ^' ~^~ (Complete inTelplicate) <br />/--�-- Date issued <br /> - -- This Permit Expires I Year From Date Issued <br /> San Local H�u| , D|*hc, 6x o permit to construct oninstall the .�vox.�rk� <br /> herein <br /> Application is 6 to the tyOrdinance NO'. 549 and existing Rules and Regulations: <br /> described. This application is made incompliance with Cmun <br /> . -.-. --���� <br /> � '-- ADDRESSone/LOCATION <br /> Name <br /> '---''-----'-'-- <br /> _ ��� <br /> � ---� Phone .`^��=^�,^~`.*.~� <br /> � <br /> Contractor's '`~''- '~-~-'� ^i6ence �msn� Howen�1 [ornmne�|u| J�T,pUeYCoor -,E] <br /> / <br /> Installation will serve: ue» J���p" , <br /> � <br /> motel [:]other -----------'_'-'_ <br /> ^^ �]L e ��|n�or bm �zm ^�------------------ -- , <br /> � Num6er of |k��g units --- Number of bedrooms .�~~-'-'um,o�a ---- <br /> \WotorSupp|\o Public System and name --------------------------------_---------------------------- ------------------------------------------- )i6te�~ <br /> ' Cho�����| �u depth �3 feet: ��� �|Y� clay E] Peat El Sandy Loam F1 Clay Loam ~ <br /> Hardpan Adobe-0 Fill Material ------------ \tyes,type ----------- , <br /> ells <br /> ,etc. must bie placed on reverse side.) <br /> v'"' plan, showing^` '-^ - -' ' ' - ~ <br /> ` ���V�U�0���������; (No septic tank o" seepage pit permitted ifpublic sewer isovoUo6|evv��n �UO <br /> | ' - ~ - Uqo�'[�P� --------------- <br /> Size <br /> - - <br /> 8�e . __________ ~� <br /> / {1 SEPTIC TANK <br /> ] _ � __ ______��.. _`__ � . <br /> PACKAGE' - �-- <br /> Type Cop ' — ' - ^v/�/ �� ' No'.. --'`����� --'----- <br /> cy --- - '- - — p <br /> 'FoumJuMun ` '`Prop!Une .-.--`-^'-^-_ <br /> D|�ono, to nearest: Well --.-'----'---- � - <br /> - <br /> |�n�t6 of each |h`� -. Total 'Length ----''----- <br /> � <br /> 'LEACHING LINE [ ] �o ofUneu -'---�--- -_'~- --'----- � <br /> - 'Q' Box .-.-.. Typo Filter Material --------------------Depth �|�r o| ----------.-'''---' <br /> | Digonueto nearest. Well -------'. Foundo+|on' �r,.---��'�-�Pro�eM� Line ------------------------ <br /> Distance <br /> -_-.-_.-- <br /> Number Rock Filled �e� [� No �] <br /> 3�EPA�EP|T [ � <br /> Depth --^--_ CAo�e�nr --'-'_ �� -.-_--_-- <br /> � . <br /> | -------�-- �pc�S�a -'-'--'- ~ <br /> / VVo+or Table Depth '---_---'_'_-'-�-_ ' ----.- ~ <br /> Foundation Prop. Line <br /> --'--.'.�--. <br /> D\�onoe �u nearest: Well ._-_'_----'_'_- ----_-. . [ <br /> �--__ <br /> REPAIR/ADDITION~ �r�v' Sanitation Permit# ------------------------------ <br /> onitaGonPnrnit# -__'---_--_-- Data ---------------------------------- <br /> ------ ---------- <br /> septic»npnc Tonnp,p*"'r ~ey~ ~' ^^~' -------------- � °�Aw �.-» <br /> --- <br /> Disposal Field (Specify v|rnmon�) � .- <br /> n on reverse side) <br /> �_--_ __'� <br /> ^ <br /> ' ne with Son Joaquin m <br /> n�c�re u ed addition <br /> � mo mn� �� � � <br /> | hereby certify .that | have prepared this app � ���W� District. Home owner wr �«wm- <br /> � <br /> an <br /> \. <br /> �n� 0 �u� �w�wnw �f �� �mm ��mqnUm �w« <br /> County Ordinances, State Laws ^ <br /> sed agents signature certifies the following: ^ f 0 � nammm' <br /> "I certify that in the performance of the work for which this pmrm|t |s |swu*d' Iwhy| not employ any pen*m� � � <br /> as to become subject to.Workman's Cwnpe�w��mn .=° " °^ ° <br /> ON <br /> Owner <br /> - <br /> By - -i>A16--�_ ---- I <br /> (if oKer than owner) <br /> FOR DEP TMENT USE ONLY <br /> � ------ <br /> ------------------------------------------------ <br /> _''_'_----.---._------------------.-_------- --------------- <br /> --- . <br /> ^ ---'----��� --'---'`����[ <br /> '---�--- n~tY--''---'--'--'-' -Do�e u� 'i�l\-\�[��'�---' <br /> ----- ~�U�� y�� x' ----- \�f <br /> . �no} |nspoc�on6y ---._'__ .,.. '--_-_-_---'-- _ ~^ <br /> ` Sf\N JOAQU|N LOCAL HEALTH DISTRICT <br />