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FOR OFFICE`USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> X9 /9- Permit No: ---"------- -------- <br /> (Complete in Triplicate) <br /> --------=----------------------------- ----------------- <br /> ---------_--------------- This Permit Expires 1 Year From Date Issued - Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> I described. This application is made in compliance with County Ordinance No. 549 and existin Rule and Regul tions: <br /> JOB ADDRESS/LOCATION �_ l_/� �i�_ <br /> _^_----- _ -/_.�.�- - ---------CENSUS TRACT ----�------------------ <br />' Owner's Name /�-4..-"-•� / F � ------- -------- ------------------------ <br /> ------ ------Ph e <br /> Address - ----------------- '�--------- ------------------------------------------------- city ------------------------------ - ------------------..._ <br /> Contractor's Name ----- -, ---`- - --------------------------License # fps- - Phone - <br /> Installation will serve: Residence419Apartment House❑ Commercial ❑Trailee Court ❑ ' <br /> Motel ❑Other------ ---------------- ----- -------------- <br /> Number of living units:-_4--_ Number of bedrooms ____Garbage Grinder _ Lot Size __ - _'_-_- <br /> Water Supply: Public System and name ------------------------------- -•------- ----------------------------------------- --------------------------Private R <br />' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ 4Clay [] Peat❑ Sandy Loam ❑ Clay Loam ❑ + <br /> Hardpan Adobe ❑ Fill Material ------------ If yes, type ------ ------ _ .. <br /> (Plot plan, showing size of iot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r <br /> PACKAGE TREATMENT SEPTIC TANK: Size_ , _.i_ _i0-�_L,** <br /> 4( Liquid Depth _ � _._.,_. <br /> ����_``Mater�ai <br /> -------- <br /> Capacity -1-- �PTYpe��'--- - =- #�-- -%7:�_'__ No. Compartments --d�-------------- <br /> x <br /> Distance to nearest: Well Length of each li Foundation ._� ___- ___-___ Prop. Line _ <br /> LEACHING LINE Y No. of Lines _ _ _ ne'_ _ ^ <br /> ' - - -�---------- 9 -' - - ---- Total length --__�.__�`-+�----------- <br /> - `7 <br /> D Box Type Filter Material __ � _ �eptrh Filter Material � _______.______._"______________ <br /> Yp } <br /> ------------ <br /> Distance to nearest: Well�a�_________ Foundationi� .�__ _______ Property Line <br /> SEEPAGE PIT [ 'D eptth _. , �_ -- Diameter�_ � Number .___ _ Rock Filled Yes " No �] <br /> / : <br /> Water'+T ble Depth --------;2g9--------------------------_-Rock Size <br /> Distance.to nearest: Well __f l ,t� __Foundatior �J F f <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ______________________________________._.__ Date _______________� _______________) <br /> .L Septic Tank (Specify Requirements) _ ______ <br /> ti ---------- - --------- ---------------------------- <br /> Disposal Field (Specify Requirements) <br /> ----------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------- <br />