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FOR OFFICE USE: 0 1 <br /> APPLI;A;ION FOR SANITATION PERMIT <br /> b�-,'7 <br /> ---- -- -- ------- ------ ----------------------- Permit No4 -7 - 93 <br /> --------------- <br /> - -,----- - "Co'mliletein-Triplicate)- <br /> 17 <br /> ------------------ -1-10-------- - - Date Issued <br /> This Permit Expires 1 Your From Date Issued <br /> ---- ----- - <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 applicationi-I is ma n-in4pppliance with,County Ordinance No. 549,a'nd existing Rules and Regulations: <br /> :�Buck RZL,. -- ---------------------------------CENSUS TRACT _S4_7............. <br /> JOB ADDRESS/LOCATION ------=-�f:777=---------------------•------------------------- <br /> Owner's Name ---- -�tj------------------Phone --------------------------j--------- <br /> ---------------------------------------------- <br /> nir i Concord -------- <br /> Address ------------------------------I---- <br /> -------1-77 8--S--',n--- - _U -0---Gt,-- ------------- City ---- -------------------------------------------------------------- <br /> Cont'ractor's Name Bla_c�ardls SeDtic T nk C Phone _____46_3_7o4a--- <br /> ---------------------- --------------a-----------0----------------------License # __26-8._952----- <br /> Installation will serve., Residence [X Apartment House°E] Commercial :E]Trailer Court ;0 <br /> i <br /> Motel ❑ Other•----------------------------------------- <br /> Number of living units:-_. ------ N6mber of bedrooms ---4------Garbalge Grinder ------------ Lot Size <br /> Water Supply: Public ---------------------------------------------- --------------------------------------------- <br /> Syste� and name ----------- ---------Private <br /> Character of soil to a depth of 3 feet: Sand'E] Silt Clay [_1 Peat E] Sandy Loam -E] Clay Loam-E] <br /> Hardpan [A Adobe ❑E] Fill Material ------------ If yes,type -------------- <br /> 'll <br /> (Plot;plan, showing size of lot, locatio .of W <br /> n _J-I�relatioq- to, ells, buildings, etc. must be placed on revers side.) <br /> NEW INSYALLATION: (Nb septic tank or seepage pit.,permitted if public sewer is available within 200 feet,) <br /> ,_ _ .- If]-,I� . ..rz - I <br /> PACKAGE TREATMENT SEPTIC TANK'] Size_-___.2 Liquid Depth ----- <br /> Capacity aterial__&a,�,& No. Compartments --- ............. <br /> M <br /> / ----Foundation ----Z(,7 ------Prop. Line <br /> Distance:11 to nedeesf.,Well ---------jtK_�L�------------ <br /> LEACHING LINE W No. of Lines - __'11*1) ____ Total Length ............ <br /> -f—-------- L�-n6th of�,eac'h line------- <br /> A. "I <br /> 'D, Box Type Filter Material ----- .__Depth Filter Material -----------Property Line --------- ------------- <br /> .4�,_ <br /> Distance to nearest:,Well'. 11�� <br /> SEEPAGE PIT 41 D I pth ----- DiAeter Number r -------------- Rock Filled Yes 0 No C] <br /> qJ / o,/ ------- -,- <br /> Water Table Depth --- -- ---- --e -----------Rock Size --------;r----------- <br /> ------------------ <br /> �00 <br /> Distance to nearest. Well -------------- {_________________Foundation Prop. Line __Xaa---------- <br /> As----- --- <br /> 'anitation Permit <br /> --------------- -------- <br /> REPAIR/ADDITION(Prev. S ------- Dater . ...... <br /> III` <br /> Septic Tank (Specify Requirements) --—--------- ----- ---- - - ------------I---------------- -------------------------- <br /> J1, <br /> ----------------------------- ----------------------------------- <br /> Disposal Field (Specify' Requirements) ------- a-___`-'------- ----------------------- <br /> ---------------------------------------------:----------- --- . ....... <br /> :Ili <br /> -------------- ---------------------------­-------------------L---------------------------------------------------------------------- --------------------------------7--------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepclied this application that the work will b_e'clone in accordance with Son Joaq"in <br /> County Ordinances, State.: aws, and Rules and Regulations of the San Joaquin Lbcall Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> ,11 certify that in the performance of the work for which this permit is issued, I shall not employ any person. in such manner <br /> as to become subject to Workman's Compensation laws of California."," <br /> Signed --------------------- I------------------ ---------------------------------------------- Owner <br /> By ------- ------------------------- Title --- ----------------------- --------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> PPL P LICATION ACCEPTED ill6y -------------------------------------------- DATEeP_7A��7Z------------------ <br /> BUILDINGPERMIT ISSUED,: -------------------------------------------------------- --------------- ---DATE ----------------- ------------- ----------- <br /> ADDITIONALCOMMENTS!� ----------------------------------------------------------------------------------- --------------- ---- ----------------------------------- -------------- <br /> -------- -------------------------------- ------------------------------------- -----------------­­­--------------------------------- ------------------------------------------­------I--------- <br /> ---------------- --------------------ii.--------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ---------------------- --------- ------------ ---------- ------------------------------------------------------------------------------ ---------=------- <br /> --- --------------- <br /> Final Inspection by. ------------------------------- ----------------------- - Date -- — <br /> - ------ <br /> SAN JOAQUIN-LOCAL HEALTH DISTRICT <br /> L E. H. 9 1-'b8 Rev. 5M., <br />