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FOR OFFICE USE /'A►PtICAT10N FOR SANITATION PERMITFOR OffsCE U5E <br /> .. I If=�nffefe In Tripliweq Pe,+, i No. 7157-AO 4' <br /> This Persalt Rsplres 1 Yew hent Dote Issued I Dore Isa,:td <br /> App)twtion.i hereby made to the San fooqutn tocof Health District for o permit to consh. , and wo.k herein desrr.oed <br /> This appl,cation is mode <br /> in Give with County Ordinance No. 540 and eyr.ng Rol s a'n`dRequ.otwns <br /> e <br /> JOB ADDRESS/LOCat Ani` 5 (.l6 !` CENWS TRACT <br /> Owners Nome wh.r a r / _`..'_f Phone <br /> Address ! VA7r ��y�`—�'� Ye 7 City......r/�'�tr- 3;71- Z.p <br /> Contractor I, ea <br /> Nam0 A'!� frv6+ "+ Lnse. `��4. Phone <br /> .naratlonon will wve. Residence Ej Apornnent Novte 47 Commerclot Qj--411193er Court C <br /> Movi C Other .- <br /> Number of livmq unrri; /... .Number of bedrooms Gurbage Grinder:-•j .....tot Sift.., <br /> 4 J" <br /> Water Supply: Public System and name <br /> Character of sod too depth of S feet, i Sand o Stit C. Cloy L Peon team Q Cloy Loom C] <br /> Hardpon j] (Adobe C F.it Mater..o' If yes, type.. ..... .... .. .... <br /> iPlot pion, showing size of let, lowborn of tyt'em ut rotation to wells.buildings,etc. must be placed an reverse side.! <br /> NEW INSTALLATION: (No septic took or wepooe pit permitted,f public sewer •s ovaitobte within 200 fear,] Z. <br /> PACKAGE TREATMENT ( j SEPTIC Tiuvrc ,'1 • '1)e j— ,9 L q"'"! D f <br /> Copocity. TV" 1G� Material �+b Comparrmerms ...... <br /> s <br /> Foundot.on �O <br /> Otstmtce to n�nu: Well �� ,�. <br /> LEACHING LINE I j of tines l. . Length of each Ilne.. O Total length f <br /> '0' Bos 4110 Type Filter Mo oria! jbCr Depth Filter Matertd fd CL. <br /> 40- <br /> Dtstance to rrorest:Well/60, ' Foundation.. <br /> /,& ' Property tins .Cyd fr,,ff <br /> SEEPAGE PIT I DepthtsF ear .S Number Rock f46ed Yes(j No L. <br /> Water Table Dearth.. .. .. _.__. Rock Size ___.... . _._._ <br /> Distance to necrest, Well FowSdotian Prop, tine <br /> REPAIR/ADDITION (Prov. Sowtitot oo Permit It pate --1 I) <br /> Septic Tank (Specify Requasimtentsl _... .._. . <br /> Dispotaf Field (Specify Requnements) _ ti <br /> Yl. <br /> t <br /> I Urow ern tt ung rind (nfu,red odo.t.on on reverts &,dei <br /> 1 hereby certify that 1 have Prepared this application and that the work will be done in oct"a"ne with San Joejain Count <br /> Ordinances, State Low%, and Rotes and E/gulatieM o1 the Sen Joa/uin local Health District. Memo Owner of Licensed 66001 <br /> Signature terrifies the fallowing: <br /> "I certify chat in the pefferrnance of th. work for which Nttt permit la issued. 1 shall net OMOJOY any person in such manner a-r <br /> to became subject to Wed.mons Co��mpppensoNen iaws of Califwaie." L <br /> uvirnerr <br /> by r gneu ��X�Gr" ro <br /> Br rel® <br /> 111 other than owner) <br /> -- I FOR " Al TMEVT USE ILLY _____.._ ---r--=-- :-- <br /> --— ✓_;/5-74 <br /> APPLICATION ACCEPTED BY _ ` DATE <br /> DIYISiON OF LAND NUMBER r - -` OATE <br /> `11I0NAL COMMENTS . .. .. _.. <br /> Final inspection by. .. .. � '.. Date <br /> res ate. if rite to <br /> to 13 24 SAN JOAOUIN LOCAL HEALTH Ot ftICT • <br />