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FOR OFFICE USE: APPLICATION'VOR SANITATION PERMIT <br /> .............................-.... ................ # <br /> (Complete in Triplicate) Permit No. .7�-. �. r <br /> Date issued <br /> ......................... This I This Permit Expires i Year From Date Issued rr <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described, This application is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations: t <br /> I <br /> JOB ADDRESS/LOCATION CENSUS TRACT .......................... <br /> Owner's Name _. .lza..._ /. i!'t. ............................_................--r......................-..--------Phone .S 5'Q.m., <br /> Address .... ............._.. .....................----------------- ---___.......... City .�\ -.....L7..!��- ! !..-.......................... <br /> Contractor's Name ..............:License q(s .... Phone ��. /�- 7c: Z-9z'-- 3 <br /> A ,. <br /> installation will serve: Residence El Apartment <br /> House <br /> _ { House0 Commercial raller�Y <br /> Motel ❑Other R ❑ i <br /> Y0 f <br /> ,Number of living units;.. ......... Number of bedrooms --- Grinder -ltiG7.. Lot Size ....... 7 C!!.1Pis.........- <br /> i <br /> .Water Supply: Public System and name ............ --------.....................—............_........---.................I.................------Private,( ' <br /> Character of soil to a depth of 3 feet Sand Silt O Clay ❑ Peat❑ Sandy Loorn,0 Clay Loam 0 <br /> Hardpan ❑ Adobe Q Fill Material ..._...--If yes,b'p9 r-........... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) 1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f I SEPTIC TANK I I Size... . . . --= LI uid De th .............:............ <br /> Capacity .. a -- Type A ..11. Materlak.`CMA+-7` No: Compartments ......�...._....i <br /> �. Distance.to nearest: Well ....... -.............Foundation ......... Prop. Line .. ... ..... <br /> LEACHING LINE f ] No. of Lines --`---- - ------ Length of each line- �'2c2-l...--.- Total Length <br /> D' Box .- � Type Filter Material 1. �.......Depth Filter Material .. �. ........... <br /> to nearest: Well -----7e.'....:,.... Foundation .. `�}..a- <br />