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FOR OFFICE USE: <br /> APPLICATHM Wit SAWATION PERMIT <br /> ......................... <br /> (Complete in Tripticate) Permit No. .............._...... <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 /> described. This application Is made in ompliance with County Ordinance No. 549 and existing Rules and Regulotions% <br /> JOB ADDRESS/LOCATION ...CENSUS TRACT ... <br /> Owner's Name .(' ..............:.........:..........................:................Phone <br /> Address . .. ....- ............City ..........................................,.................................r� may..... y <br /> Contractor's Name ...`.�i� � wa. ......................�_....Lkense # •6.• �:/•, Phone <br /> Installation will serve: Residence CT4artment House{] Commercial QTrailer Court E] <br /> MotelQ Other ............................................ <br /> Number of living units:_.J..-:::. Number of room: . G <br /> ....._. arbogs Grinder Lot Size .................................. <br /> Water Supply: Public System and name .---•--. -•-•............._..........................................................................Private Q <br /> Character of soil to a depth of 3 feet: Sand n Silt 0 Clay Q Peat Q Sandy loam 0 Clay Loam m•--•---- <br /> Hardpon o Adobe`o Fill Materlal ............ if y*s,type............... ............ <br /> (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION% (No septic tank or seepage pit permitted public se r-is avallabi within 200 feet,) �. <br /> PACKAGE TREATMENT f ] SEPTIC TANK{ ] Size. . Liquid Depth A/...... .......... <br /> Capacity J.-Af.r.... Type . Material.--l. ? ....... No. Compartments ...�;.. ......... <br /> Distance to nearest: Well ..... ...... .........Foundation .f.0............ Prop. LMe .lam..... ...... <br /> LEACHING LINE f ] No. of Lines ---�............... Length of each line........ . .. Total Length .?. J <br /> 'D' Box /........ Type filter Material ....................Dopff fitter Material ................................ .. 6 <br /> Distance to nearest; Well ........................ Foundation ........................ Property Line .......... ............ D <br /> SEEPAGE PIT [ ) Depth i f X.3v.� A.?Diameter ................. Number ..../....................... Rack Filled Yes No 0 Z <br /> Water Table Depth ............... ..... ..Rock Size <br /> . •- , �-............. <br /> Distance to nearest: Well ....... -.10........Foundation .................... Prop. Lien ..................... <br /> REPAIR/ADDITION!Prov. Sanitation Permit# ............................................ Date .................. ..............) <br /> SepticTank (Specify Requirements) --......................................... ............................................................................................... <br />