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FOR OFFICE USE: <br /> ' ApPI.IunoN roR sANrtAnoH MMrt <br /> Permit Nlo. ./�. <br /> (Cen+plNo In Triplicem <br /> TMs peewit Ltxoree 1 Year From Doh Mawr <br /> Application is hereby made to the San Joaquin local Health District for o permit to construct and install the work bewMr ; <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Rapid d%m <br /> Joe nooa>Ss/LOCATI 7!7.. ... / /.� ...CENSUS TRACT ......... ....... <br /> ».»...- <br /> _. . ... .. <br /> Owr?Ws Name � � ... _ .....Phone ...................»... <br /> Address 71 �!I�"er/ � i. ... City �k�p ... ............ .....................»..».....». <br /> --� A �.,..liunse#�3s�'Z Phata <br /> Contractor's Nome . _.....:<Z%f't�..�..t,+oc...�•� .. ....... ,/.��.:r�.C'•� .. ........ ........... <br /> Installation will serve: Residence❑Apartment House t]Commercial QTroller Court ❑ <br /> Motel Q Other............................................ <br /> Number of living unite----.... Number of bedrooms .:r ...Garbage Grinder ............ lot Site ........................... <br /> Water Supply: Public System and name ........................................................._.............................................- -pillvola <br /> Character of soil to a depth of 3 feats Sand❑ Silt Q Cloy ❑ Peat❑ Sandy loans 9!( Cley Loom C3 <br /> Hardpan❑ Adobe 0 Fill Mohrlal............If yes............................. <br /> (Plot pion, showing size of lot, Iocwion of system in relation to wells, buildings, etc. must be placed an revero dd&3 <br /> MEIN INSTALLATION: No septic tank at seepage pit permitted If public sewer is evadable W"200 feed 6• <br /> PACKAGE TREATMENT { ] SEPTIC TANK t ] Size................................................ Liquid Depth ............»»....»..•.l <br /> Pince to neorests Well ...................... �Foundation ...................... ...............»....—� <br /> LEACHING LINE No. of lines ..... length of each line..... ...............'...... Total Length ....................... <br /> 'D' Box ..... Type Filter Mehrial Depth Filter Material ...................................-- <br /> Distance to neorestt well ........................ Foundation ..... ............... .. Prey Lim ................... -I. <br /> ( 1 .. Olanmter ......_........ Number ........................... <br /> Rock Filled Yea ❑ No Ce <br /> SEEPAGE PIT Depth .................. <br /> Water Table Depth --Rode Size <br /> Distance to rarest Well ......................................Foundation .................... FV*p. Lim ......... .� <br /> REPAIR/ADDITION(Ptev. Sanitation Permit# ......... ............................_..._ Date ................... N <br /> Septic Tank(Specify Requirements) ...................^.............. <br /> ........ .........�fi�...�. ............_......_...... .... ...................» .. <br /> =old (Specify Requirement) ��� .... � �G <br /> . . .... ........................ _............................................_.. •-- <br /> .. ....... .. required addition on me _ <br /> (Orow existing and requ _ <br /> I hereby "eft tial 1 Ilam""and this MFS est of 60 Son J1964414 Deal ftekb Dk*kL N~OR~w Rte' <br /> cownsy � Stam Laws. mrd Uwe and Regal otens <br /> sed eyents ell spree cart+Nes Me f0NOv bg: <br /> w arlity 1baA M eir.per%mrmsce eE 9 *WVk hr W"lhb p«sdf as issster.1 drill eel etsrpMy a"Is~he�''"r111e� <br /> as%beaem sobject to Wakurew s CsrnpanaNM Mm of Cowell <br /> Signed _ OWillf�l�............................................ <br /> ............................. .......... '✓?J-.i��....... .Ti♦le <br /> (if aNtar Ilton owner) <br /> FOR DepARTMENT use ONLY - <br /> ...... DATE � �z ? - <br /> APPLICATION ACCEPTED by..... . <br /> ... _ '!c/--- -_•..»..._.......................................DATE ».............. ....._... <br /> iWILDING PERMIT ISSUED..................................................».....»._................................................. ........................... ........ <br /> ADDITIONALCOMMENTS....... .. .................................... .............................................. ...:........... ... :........ ........ ... <br /> ............ <br /> ...::...:. ...u'.....;.................................-_.:;&......... . .. ........ ..............Date..... ••/D. .7,,s...".. . <br /> Finel Inspection by. ....................... ..T'................. ®� .�M <br /> EH 13 2h 1-60 Rev. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> G�% <br />