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1 I <br /> FOR OFFCE USE: <br /> =OR Obi iCE USE: '�:.;;w,.�►1�_LICAIICN FOR S WTATICN PERMIT <br /> . Permit No. <br /> Beate issued <br /> '{Complete in Triplicate) <br /> This Permit Expires t Year Proms Date issued <br /> for a <br /> ermit to construct and <br /> the <br /> Appiiention is herr:lsy mode to ti"r iiSon Joaquin <br /> CnLocalHe <br /> Ord�na ordinance anpci existing Rules oncl Regulations. wnrk herein described. <br /> TF is apnc iccrt'or: is made in camp r v� `` <br /> CENSUS TRACT . <br /> j0 <br /> 0 <br /> A- 1Fs51 MsCATtOr _ -.. �Po <br /> _:r <br /> r F ._.. ..... City- /.._ - <br /> � <br /> !-:. ,--- ..^- • Ice 5E �.� - .. an <br /> r' <br /> C:ar;�raetor's lvlorr�E .. �.... <br /> G <br /> .G <br /> ^—"Re" i en ""A.partmeit <br /> j5 _6�I Somme cciai`�'""Trailer"Coiar� <br /> �stcalcatic nail serve: t! ' <br /> Motel (� Other... - 6 '� __ v '7!fr <br /> Nurrbber of bedrooms.-..Ga€brage Gsinr r .- .d of Size- ._ j <br /> v rrri er a: I r' dsnitse Prrvta <br /> w is S tem rind rufne s. <br /> .. <br /> UateY Susapty `� . , ys r - f !> r Peat; n Loom_ CIGY Lamm <br /> Silfi Cla _ <br /> Chvrra ter serf Soil t,:: a depth 0; 3 feet: Sana [-1 t f � ifs es � <br /> I Hordpc;r 0 Adobe q Fill ll+lcatePiai y_.. +��� <br /> _ - <br /> .. _ ._ , <br /> ,,Piot Liar'. st;cawvirc �9 e of ?rt, iczcatiorg ref,system irp relation to wells, uit� jA et > mu5t be placed un seders side} ® _ <br /> NEW 11+lSTALLA iC fa Rvs� se stic tcs k$orwse*epar a pit permi'ited if public i5 0V stable +within 2f} fees} <br /> AACKAC�E NEAIMENT ! <br /> SEPTIC 1�4N1C , <br /> qp No.Capacity Type-PW <br /> C orng�cartm�ts.... <br /> i ,.. ....- pr tirl�- <br /> B;sTonce to rsearest:_Weti.. C �+ '^ Teatcal 1.essgth <br /> ,......_.I.�'pgth of each line. _. ... .... <br /> a <br /> _k,C.HtNG t1t:E [ '1 l ia. �?$ Unes'', / <br /> _.._ ............. .. De th rlter Maternal - <br /> ` „ , Type Filter iatarirai. i? P . s <br /> -...a..W. .. t.. sg <br /> • .,. � { B cox . Eourtdatinnlr�.-�-- -.',. .Pr.c�pertY Line- � � ... .. <br /> & <br /> 3s1dr�c .ta riesares#: �tVei,.e�. 4Zgek Filled yes J Nn <br /> Diameter '.._ } <br /> ock Size- <br /> Water <br /> 'Table Eaepth ,I.K�t <br /> . . Eautidat}or: .".... .....Pr p. i.,rs€: .... ._ <br /> z s <br /> l�i�Tda�ce tea tree€esti Well :.... .. . .. -� 3 <br /> REPAIR/ADDITI N (PrPv'Sanitation Permit# <br /> r <br /> `:e c Tonk„S ef, Regaaire <br /> Bi%posol Fir*id d,�ta�*cl y }e Erementsi �.. <br /> ,` ',(Dw existing ioi nd required radditipn n everse side) . <br /> stats <br /> t. erred thiT`a�ppiictt3on grid that the work a dame in ®ccordaonce w#h Son loos{�rirs County <br /> hereby certify +)teat I <br /> have prop Uiatiams of the San Joaciulg- oval t#ecrith Disteict. flofne ownesr or #"rterisesl act g <br /> rdinoncest State laws, and Rules and $ � ��' � <br /> signature certifle's the folls�vsairtg: -- rsIry"8 s�E rnoirrses as <br /> R <br /> k.i car#1fY ren�Cey�# t e work for which this peren►t is issued, ! is not arrtplay i►�b" � <br /> ' th`at in the pe ,, <br /> t become sub « t n°s penis ani laws of Cliirrtia."° <br /> ,Owner <br /> Signed. .. .. . 1- - .-1'itie... i <br /> ..° ...... (if Cather than owners " <br /> . _ PC]R't)EPARTMllit4T USE ONLY"- <br /> _...- <br /> _�_ DATE <br /> APPIUCAT<)N ACCEPTED By <br /> F <br /> ABBTt '�ALAND NUMBER <br /> - <br /> Date.,�.. . <br /> Fis 11-ir'nection byti <br /> SANJOAOU, C3CAL HEALTH DISTRICT <br /> Eli <br />