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Y <br /> FOR OFFICE use: APPLICAVON FOR SANITATION Pam <br /> Permit No.....7 <br /> (Cenrpt*te In Triplicate) <br /> .......................... <br /> This Pem it Expires I! Year Frost Date Issuer: Date Issued..�... <br /> Application is hereby mods to the Scan Joaquin Local Health District for a permit to cansfrutt Arid Instalthe waft hesek <br /> described.This application is mode in co7�A►ionce with Countyy Ordinance No. 549 and existing Rules and Regukttfonsr . <br /> a J09 ADDRESS/LOCATION • .....................C�15 TRACT .. '/ • <br /> Owner's No 4 %Paz .:fid � . 7 »....... / ...Rhone <br /> r <br /> Address C7& ...._....._City.....cs/; <br /> .-. rR-h.--o-d-•e- -- <br /> Contrarior's Norm . .......-�i0erfe� ......... <br /> .. ...�...-.._..-.. <br /> Installation will serve: Residence IXAportrnent House 0 Corrtmen3al OTrailer Court C) -' <br /> ii Motel 0 Other.. ...... <br /> Number of linin units_.... Number of bedrooms Garboge Grinder trot Size . <br /> q ..... .. r��C t.` t. ��r........,... <br /> Water Supply: Public System and name .....................».. ...._......._..........__. _._.................._...........Rrlvatt� <br /> Character of soil to a depth of 3 feet. Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loom 0 due(Own <br /> Hardpan 0 Adobe], Fill Material............If yes, <br /> (Plot plan, showing si7.e of lot, location of system In relorhan to wells, buildings, etc. must be placed an rtvww s(d.4 <br /> NEW INSTALLATIONS !No septic tank or seepage pit permitted If public sewer is available within 200 feet,I , <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ] size......—---------, Liquid Depth <br /> Capacity ..........--•-Type ................ .. MAcr ria)................._. No. Comparl"Mm s.N.•� ;, <br /> Distance to nearest: Well ...........».....»._._......Fontdation.........____Prop.Lent .....».� i/` <br /> LEACHING LINE ( ] No. of Lines ........................ Length _......»....� ._.... Tota! »....�.... _�' <br /> of soot line_. Length <br /> •D' Box ............ Type Filter Material ....................Depth Filter Material .................._.._......w..._..+ 1- <br /> Distance to nearest: Well ........................ foundation ...................»..- Property Line •--».-»..- t�• ; <br /> .............. Diameter ................ Number ............................ Rock Filled N <br /> Yes � o <br /> SEEPAGE PIT [ ) Deptir ..__. <br /> Water Table Depth ..........................`»........_...Rock Site'.......................... <br /> » <br /> lDistance to nearest.. Well ........................----------Foundation ....».............. prop. UM...... � .. 'I•. <br /> E REPAIR/ADDITION(Prov. Sanitation Permit#........................................... Date <br /> Septic Tank {Specify Requirements} ... 7G1 ^. ...... .»....»........__................. <br /> Disposal Field 15pecify Requirements) ......./...... a r a�cse.,+ .......................... .... ..... ............».»»... <br /> ........................... <br /> ..... ................................... .�.. �'^ —... ... ».... ...1.,F. ..,... <br /> ...... ......................................_........................ ._�.. .. f?....... ... �Y _.- �/ �.t..7.4.++.}} .. <br /> !Draw existing <br /> and r uired odd an reverse side[ <br /> I hereby certify that I have prep*.--( this applicatfen and that the worse wMi be dere W accordance wlfls Ess Akgdn - ,y <br />'. County Ordinances, State Laws, and Rules and Regulations,of the San Joaquin Local He" Dislefd.Herne twrter er 1108W <br /> $ed ogerrh signature certifies the following: <br /> "I certify that In the perfonrr nce of the worts for which this permit Is issued,I shalt nes employ any person M$*A ens NW- �t <br /> as to becorne sn ed IoWo rn 's Compensation ( of Ca a." <br /> Signed ......... ..... e. . .t.... .[a< ."t t''�:.....mow,,, <br /> 7 tie _ r� .. <br /> By ..:.. ........... .... ............. -•--- ...._........ i ...'-- ......................... <br /> (If atyer than owners • '�' � <br /> FOR DEPARTM USE ONLY t <br /> r :- <br /> APPLICATION ACCEPTED BY.� tl�.G2- .`^ ....._......................._.. DATE ......SA...... <br /> BUILDINGPERMIT ISS ............................................ ............................ ............. ..............DATE. . ................................ <br /> r� ADDITIONAL COMMENTS..... ..... ..., . .................._..........-------...-....................... ... .-...,...-......- .... ... ................................. <br /> ... .. .. ............ <br /> ............ .... . ........_................................... <br /> _ ................ -........ . . .... ... ... ............ . .... <br /> ... .. ......... <br /> T: Final ins non b -��... Date �f •./.•- <br /> EH 13 2h1-68 Jtcv. 5M SAN JOA N LOCAL HEALTH DISTRICT 5/74 3H � <br />