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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br /> Permit No. ...7 ��07 • <br />...................................................... (Compietein Triplicate) <br /> ............................ Date Issued... ..�.'........... <br /> This Permit Expires 1 Year From 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 /> is made in compliance with County-Ordinance No. 549 and existing Rules and Regulations: <br /> described. This application P . <br /> 9156 Shelton Road .............................CE TRACT .-................... <br /> ..,:. <br /> JOB ADDRESS/LOCATION ....CENSUS <br /> Bi11 Stone-•76Lockt•ord-Mobile Sales ..............................Phone._-....... ........... . ... . <br /> wner's Name ---•-•-----------••............... <br /> O _.. <br /> A :...... -City •---•-•--•-- <br /> ;9356 Shelton oainden Linden <br /> ddress <br /> .................................. <br /> •---.......R--------•--•--•---- 271539 <br /> 465-2616: <br /> ContractoC s-Narne <br /> }:tato Rooter .Sewer Service -_.License # ........................ <br /> ..................... Phone ....._.._......:._.... ... <br /> Installation will serve: Residence. 1 •A artment House Commercial ❑Trailer Co <br /> . urt <br /> 1 a ri employee trainer <br /> . .. 2 9 Y acreage . <br /> 1 Motel ❑Other .............�. ' ..._ .._.. = es lot Size <. <br /> Number of living units:............ Number of.bedrooms _...._..-:..Garba a Grinder <br /> Su 1 Public System and name..--- ....................................... <br /> Y ...... --- Iva <br /> -•- _.Pr to <br /> Water p>?..Y - <br /> Character of sail to a depth of 3 feet: Sand .Silt❑ Clay El Peat❑ Sandy Loam ❑ Clay Loam ' <br /> Hardpan ❑ Adobe [] Fill Material _...._.. ... If yes,type <br /> e ------•---- ----- ----- -- <br /> buildings, etc. must be placed on reverse.,side.) <br /> (Plot plan, .showing size of .lot, .location,of. system in relation to wells, i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer;is available within 200 feet,) <br /> Size 4 hY $ b.Y .9 .. q ••••..... <br /> PACKAGE TREATMENT ( I SEPTIC TANK[ ...-._...... .......- Liquid Depth ._ <br /> concrete 2 <br /> :.. <br /> 1200 <br /> Fre-Cast No. Compartments --- <br /> i <br /> Capacity - -• --- Type ---------•• -----i Material.----•............. 10' $`,i:•. <br /> _., . . 50 Prop. Line . <br /> Foundation - <br /> 1.. Distance to nearest: Well ..........-.......................... <br /> ..---.._......... - _,.. <br /> n <br /> iaa� 90 <br /> c total tenrgfih 90 " <br /> f <br /> : ° <br /> i LEACHING LINE {.A No. of Lines 1. _. _:: Length of each (me.................--- 18 :-... .< ...... <br />` no T -e'Filter Material .••--••••........•-- Depth Mate .....................:......:. ::.. <br /> rock D Filter I <br /> • ; 'D' Box -------------- YP -. a . <br /> ri ; <br /> I : r -. <br /> Distance to nearest: Well ._. SQ'.............. Foundation ... 0.'_........_.-_ Property Line', 5' .�' <br /> l , -- Diameter - .A. . ed ' Yes ( 3. ....No .0 <br /> SEEPAGE PIT .0 j Depth _ 4 by_.6.. Number -•- <br /> $ lrr byR Filled <br /> sump; Water Table Dep =•• Rock P Line . ... <br /> R k Size --• <br /> Distance to nearest: Well --------50 <br /> ....................Foundation .-10.`.....------.. ro =' <br /> P•. . 3 <br /> ROPAIR/ADDITION(Prev. Sanitation Permit# ---_----------------- <br /> F, <br /> -•=- --••--- ...Date- ^ <br /> ....... 1 <br /> ,Septic Tank S e'ci Re uirements) <br /> ...............•...... ---....... M <br /> ( P fY q -..._ <br /> a �. .,...� ..--- <br /> (Disposal Field (Specify Requirements) ........... ...... <br /> _....-- - ...................... ..................- <br /> :(Draw existing and required addition on reverse sidel <br /> F <br /> I hereby certify thciVI,have prepared this application and that'the work will Lie done in accoidaece with'Son Joaquin <br /> County Ordinances; State Laws; andRules and Regulations of the San`•Joaquin Local Health District. iian►e owner"or'Iitaiti- <br /> sed agents signature certifies the following: . ' <br /> "I+certify that iii the performance of. the work far which this permiit"is issued, I shall riot employ any person in suclh mrinner! <br /> as to become subject to Workman's C*mPens0tl0n laws of California." <br /> i _..: : <br /> ,. Owner <br /> Signed .---- -• -----•._.. <br /> Contractor <br /> Title .......... <br /> ....... ......... .............. ........ <br /> er than owner) <br /> FOR-bEPARTMEN'f. USE ONLY . <br /> L IDATE �`_.... ... <br /> APPLICATION ACCEPTED BY .... ..: .................._:• i <br /> :.. <br /> BUILDING PERMIT ISSUED --­ .=._ AT <br /> - <br /> ADDITIONAL COMMENTS , � :.Q. ... . . �.v ....................................- <br /> . . <br /> •... <br /> ....................................: <br /> --.................._ ••.._..... D <br /> i <br /> Final Inspection by: ' <br /> Date • <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT „ _ �- <br /> _ _.7/72 3 M <br />