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Ln <br /> Z' <br /> FOR OFF,Ct USE: !i FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Cernple% In Triplicate) Permit No. .SE' <br /> �8-$ <br /> Date Issued /O <br /> This Permit Explres 1 Year From Dote Issued -_ <br /> pliG—ion :s hereby mode to the San Joaquin local Health District for a perm,t to construct and install the work herein described. <br /> s opplkotion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 8 < DRESS/LOCATION CENSUS TRACT <br /> vne?l Nome Roo L G 010 •r ,C Phone . .................. <br /> Pdreaa � C. City ... ......,.Zip........ <br /> .................... <br />,nt►: tor's Nomel/w•Ie1�Gf• �' ',r /' )e'Woo A�.:oeAr A -� :orf license +Y .E� .' s = Phone�1/.�"`�JAP-A6�.Q!• <br /> tallotion will serve: Residence® Apartment H.)use❑ Commercial ❑ Trailer Court ❑ <br /> T^ - <br /> Motel ❑ Other ; <br /> !A-it,mk of living units: Number of bedrooms Y Garbage Grinder Lot Size if r•A_100--A- <br /> iter <br /> er SuPPIY' Public System and name s• <br /> Private <br /> orc er of soil to a dept's of 3 feet: Sand [ Silt❑ Cloy Q Peat❑ Sandy loam(N Cloy Loam ' <br /> Hardpan ❑ Adobe 11 Fill Material If yes,type <br /> of plan, showing size of lot, location of system in relation to wells, buildings,etc•must be placed on reverse side.) <br /> i <br /> W IISTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />�CK._:aE TREATMENT ( ) SEPTIC TANK X19 Size /1 400 trr I!b L &* ,*,, Liquid Depth <br /> Capacity -?'/r Type Matecial No. Compartments X <br /> • • <br /> Distance to nearest: Well / soe' '0 roundotion D► Prop. Line .... ._.� <br /> 4Ci, V LINE O No. of lines length of each line Total length . .. . .... ............ . <br /> D• Box Type Filter Material Depth Filter Material ..... .. .. _.. _... ....... <br /> Distance,to nearest: Well Foundation Property Line <br /> epAvo Depth L 7 Diameter ABY XV d Number Rock Filled Yes® No❑ <br /> r <br /> a— pl e J O Woter Table Depth Rock Size 1 /.Z <br /> Distance to nearest:Well ! •4 Foundation Prop, Line I Zr... <br />:PAW'ADDtT10N (Prev. Son.lotion Permit I Date 1 s <br /> ptic'onk (S-,)eeify Requirements) /.,- 7• X 04L L"0 " <br /> spc 11 FNId (Specify Roqu:romentsl l o 'X y o ' )k J►,? ",P A ! -' . t Wr d :. ;A <br /> (Draw existing and required odd tion on reverse side) <br /> oreT'y terlMy that 1 have prepared this opplkation and that the work will be dens In accerdence with Son Joaquin County <br />,dinancos, !late Laws, and Rules and Regalatle,ns of the San Joaquin local Health District, Meme owner or licensed agents <br />-,me n►cexrfltes the Wlewing- <br /> ce..Jy #hat In Ilte perfe►manco of rte• work for which this permit Is Issued, I •hall net empley any person in such manner as <br /> becensto weri•mon-s Cornpensalton lows of California." <br /> •.� e,1 �' t ��e . <br /> Own." <br /> • <br /> 7.910 <br /> 111 otter• Mor+ owne►I <br /> FOR DEPARTMM�! Wit ONLY a� •may <br /> AT,01,1 ACCEPTED By l�irt�C�ir IG/«'�.'��-- DATE 011 <br /> �0 ' <br /> S ON OE LAND NUMBER .001 DATE <br />