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r <br /> „ <br /> FOR OFFICE USE. FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ` Permit No;,7F- 6s3 <br /> (Complete In Triplicate) <br /> Date Issued 149,3 <br /> This permit expires 1 Year From Date Issued <br /> A'rplicotien is hereby m,�de to the San Joaquin local Health District for a perm to construct and install the work herein described. <br /> h County Ordinance No. 549 and existing Rules and Regulations, <br /> This application i made ,n compliance wita <br /> CENSUS TRACT , <br /> e ADDRESS!LOCAT OP' ` <br /> _. Phone . . ........... ... <br /> r ' ? <br /> Owner's Name r-, <br /> 'dress <br /> r City <br /> Tit-+tyle <br /> Zip .;. <br /> �.e• ' 6 . �.! t J• Phone!� :y.rj� .M ti <br /> ntrw:tor's Natnr.A�'Ie; = '.+ •:, license A► <br /> Residvnc' �r Apart•r ent Ho-se C. Commercial ❑ Trailer Court ❑ ! <br /> Ir,"llation will serve i <br /> Mote! r] Other <br /> ;`,tuber of living units i Number of bed•ooms I Garbage Grinder lot S,ze:'�O • t". y rd J1' �j. <br /> Private (a <br /> Water Supply. Public System and name <br /> oracter of toil to a depth C j 3 'Feet: Sand❑ ailt?] Clay❑ Peat D Sandy loam Clay loam [; <br /> Hor,ipun[] Adobe r-1 Fill Material If yes,type <br /> (Plat plan, showing size of I•,t, location of system, in reloti-in to wells, buildings,etc. must be placed on reverse side.) <br /> 6:N INSTALLATION: (No septic tank or seepage Fit perm ftPd ,f oublir sewer is available within 200 feet,) <br /> VXCKAGE TREATMENT f ) SEPTIC TANK p,� :,izo / %v er t► 's•- Liquid Depth 1*5 <br /> Cvpacity O I Type Material No. Co portments 0 <br /> Di-ounce to nearest: Well ? Foundation 19 Prop. Line <br /> TEACHING LINE f ) 1'5. of Lines Length )f Loch line Total length • O <br /> r-)' Box Typo Filter Material Deptit Filter Material <br /> _ D,ston-e to nearest Well Foundation Property Line <br /> SEEPAGE •PIT I I Depth D ameter .' Nun ber Rock F01ed Yes Q No <br /> it 00 C 4 i i r! t' Wa•er Toble DRpth Rock Size w 01 <br /> _ Distance to nearest: Well oft CIO Foundation .10 Prop. line S <br /> REPAIR/ADDITION (rrev. Son,,jt,on Permit# Dote l <br /> optic Tank (Specify Require-rents) /l 4-0 aw L J.4'�• <br /> b;sposol Field (Spe,afy Pequ rPrrert;) "t ,l v <' <br /> - IDraw existing and required add,tic,n on reverse Side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County <br /> ordinances, State. laws, and Rues and Regulations of the San Joaquin local Health District, Home .vnor or licensed agents <br /> 1pnatvre certtflies the follov.ing <br /> ..I Comfy that In the perforr•,nnce of the work for whicit this pe•mls I. Issued, I shall net employ any person In such manner as <br /> Is btcern• rlHfstt to Werkrnon s Compensolien lows of Cotifernia." <br /> ,igned ems♦ •lA,( �c. • .�� Ownw <br /> i r <br /> By <br /> u1 othp• thnn owner) <br /> FOR DEPARTTMMENtySE ONLY _ <br /> APPLICATION ACCEPTED By � ' �.( ys DATE �9'-+��^ <br /> OIVISICIN OF IAtiD NUMBER // DATE <br /> ADDITIONAL COMMENTS <br /> F r-0 Inspectton h ���i /�'c.� Ct!.v .�< Z Dat! <br /> s� .. SAN JOAOUIIJ IOCAL I+EALTH DISTRICT rt,21617 sry r re sM <br />