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1'VLICATICN FOR SANITATION PERMIT permit No. <br /> (Complet,In Triplicate) <br /> Dote hued <br /> This Permit Expires 7 Y•nr From Date issued <br /> 'xtavin Local Health Distri-t for o permit to construct and Install the work herein <br /> nd exlstirg Rules and Rep oHonsr <br /> -,d. This or o"spliancce�with County Ordinance No. 549 a <br /> CENSUS TRACT .... - <br /> t Phone 1iGIR� <br /> S Nome _.. 11 ^��Lca <br /> -.a r City 1 --•_-. _..... . ... ...... ................. <br /> _ License tY . .. .. Phone . <br /> ation will sere '^^'^XAportment House❑ Commerclol [3Troller Court ❑ <br /> I " -.1 C] Other _. ..... ....... <br /> n �Q.�ll•C� <br /> ^r of Gvinq i r, • . •-� of bedrooms �... .Garbags Grinder ..-.._ . lot Slse .. _... -. <br /> Supply, Pu�1 .. ^ ,Q.V�n�_._r'y ...........PrivaN.(� <br /> .ter of soil to •' Sand❑ Silt Q Clay ,� Peat❑ Sandy Loam Q Cloy loam ❑ <br /> ...'pan Q Adobe [] FIII Material . . If yes,type <br /> 'an, showlnq ._.a of system in relation to wells, buildings, etcmust be pleced on ravens slde.l <br /> 'INSTALLATION- - or seepage pit permitted If public sewer Is available within 200 feet.) <br /> ',GE TREATMENT . . -. -. - ANK O Size .. . . Liquid Depth <br /> • ;v~L T e�.�A,=k. Matsrlol C^ No. Compartments <br /> .. yp C <br /> r r C)-. .......... <br /> 00 <br /> ^arnh Well �OU..fi' _ ..... Foundation �Q.... ..... ... Prop. Line �5���. ... <br /> p <br /> 'ING :INE I ' Length of each line 1D . . - Total Length <br /> �_�L O ri <br /> Type Filter Materiel (� •+ pth Filter Material �. .... . .....L ,.. .... .. m <br /> ^,est Well 1 DOS+ _ . Foundation 3c,t .... Property line . .. . ... . ........ <br /> :L PIT ( Diameter ._ . .. Number _. .. Rock Filled Yes QQ <br /> No <br /> Depth .. ...........Rock Size . ....... . .... <br /> ,,It Well ...Foundation __ .. PMP. Line ...................... <br /> Arl„ . .... . <br /> „ lr♦ ... Date ........... <br /> _........... ._......1 <br /> -osol Feld <br /> ,. e.wmg and regvired addition on revenn sidel <br /> by certify thct I `.r�.. I this application and that the work will be dens In accordance with San Joaquin <br /> 'r Ordinaices. <'^'^ - Rults and Regulations of the San Joaquin Local Health District. Mama owner or liters- <br /> .Ants signature •.' . , vrina. <br /> • fy that in the r••' •. work for which this premie b bwad, I shall not emplo/ er y per..n In such manner <br /> -•,mm• sub;at t� + 'ImpensaHon laws of California." <br /> Owner <br /> Title <br /> FOR DEPARTMENT USE ONLY <br /> ..s ..._ _.. DATE <br /> ` — <br /> �n� Cv n ,_: v DATE <br /> _. _.. .Date <br /> SAN :OAQUIri LOCAL HEALTH DISTRICT I <br /> 711- 1 H <br /> V <br />