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FOR OFFICE USE: x <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------------------------------------------------- <br /> (Complete in Triplicate) Permit No. <br /> r <br /> This Permit Expires l Year From Date Issued Date Issued <br /> Application is hereby made to the San aquin 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 /> r.. <br /> JOB ADDRESS/LOCATION --1 A1______r -- ------------.--------------------CENSUS TRACT --5Y7---------.---. <br /> Owner's Name -------------------------------- --------.Phone -------------- _-•---------_- <br /> Address --------------------426-P1--------- -=-------- -- - -----�_ .__. City <br /> Contractor's Name __.___._.C•� ______ __�_��r-� _ t-�cLicense # I � --_ Phone _________________ <br /> --�` --- - ---------- -- --- <br /> Installation will serve: Residence ❑Apartment House,0 Commercial :❑Trailer Court ',❑ <br /> M6tel-0 Other __113e� - _ke�------ <br /> Number of living units------1----- Number of;bedrooms -__-----Garbage Grinder ------------ Lot Size ---- __________ ___________________ } <br /> Water Supply: Public System and name ----- ----- ------------•------....---------------------------------------------------------------------------Private <br /> f <br /> Character of soil to a depth of 3 feet. Sand'❑ Slit❑ Clay ❑ Peat❑ - Sandy Loam ❑ Clay Loam 0 <br /> Hardpan ❑ Adobe-❑ Fill Material -----------, If yes,type ____________________________ <br /> (Plot plan showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permittedtif�publie,sewer is available within 200 feet,) { <br /> PACKAGE,TREATMENT SEPTIC TANK' rSize_ ,! �X. _ f_r' _ <br /> C [�(] 9 X_`r Liqu d Depth N . <br /> f F <br /> r ------------------ <br /> Capacity Type MaterialNo. Compartments _ <br /> ------ -------------- <br /> W t <br /> Distance to nearest: Well ----------4�o_/----------------Foundation ---Z-!P.'---------- Prop. Line ----- ....... <br /> LEACHING LINE [lF� No, of Lines ____'___ `_ __ ,"`9_ Length of each fine------1V_.o.......----- Total Length ----- ------------- <br /> D' Box ------ --- 'Type HM—r,Material -_S_A_�------Depth Filter Material ---I!-- `--------------------.• �1 . <br /> Distance to nearest: Well - ___ -�'- <br />