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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. .7. y-- •7• <br /> ........:................................................ (Complete in Triplicate) <br /> _._.-...:-...................... <br /> .....------ - w Dale Issued ..3.: 1.:7 <br /> ---------- <br /> This Permit Expires ] Year From Date Issued <br /> Application is hereby made to the.Son 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: <br /> CENSUS TRACT ...... <br /> --JOB ADDRESS/LOCATIO � <br /> - --- ••.. .............•---...-----=- - ... .........Phone l".�" <br /> Owner's Name ----_ /. .. <br /> AddressL. .©.�_ r ..... City ......... --------------------- .................... <br /> I Contractor's Name --------_-------- <br /> I <br /> .. .S •YC- .....:....License # Z.: __- Phone -. `—?o.7...... <br /> Installation will serve: Residence []Apartment House❑ Commercial ❑Trailer Court �J <br /> I � <br /> Motel ❑Other . <br /> OF <br /> Number'of-living units:............ Number of bedrooms Gorba a Grinder tot Size ......_._.........._..... ............ <br /> I *name <br /> i .N�i <br /># Water Supply: Public System� and Hamer..-•-------------- .....----........Pr Private <br /> . <br /> e <br /> - Choracter,of:aoil-to=a-depth-of-3-feet}-Sand 2.=Siit_❑�•� -�- <br /> Clay�O Pea#[] Sandy=Loam fl Clay-Loam [3_ <br /> __ . <br /> Hardpan d Adobe Fill Mal. <br /> teria ...... if yes,type •................ <br /> (Piot plan, showing size of lot, location of system in relation to wells,1buildings, etc. must be placed on reverse side.) <br /> 1, NEW INSTALLATION: (No septic tank or seepage .pit permitted if public-sewer-is-available within 200 feet,) rr <br /> t : SEPTIC TANK S.ze , '1� ...............: Liquid Depth<:. ............. <br /> PACKAGE TREATMENT { ) <br /> 4 <br /> i ""�` Capacity --• ---•rTYPe No. <br /> ... <br /> J # f <br /> Distance jn arest'Wetl' ...�0 ...- ....Foundation .___1..Q......-........... Prop. Line . _ <br /> _... Len th of ac_h ine.__:" �...._.. _•J a Length LEACHING LINE Naoi Lines^:. '_...._ _ ► g . . ... O <br /> of I e •• <br /> j + �.. / ✓ <br /> D' Box y e Finer Mater 1 4 : <br />