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FOR OFFICE USE: <br /> - - APPLICATION FO' R SANITATION PERMIT <br /> ................. <br /> (Co4plete in Triplicate) Permi;:No -.. . <br /> .............I.................. .. <br /> ............................•••••-- - .. This Permit Expires I Year From Date Issued Date Issued ` -..... <br /> r <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> JOS ADDRESS/LOCATION 6 Stadmiazn#- <br /> __...E.,..<.................. ....__ __CENSUS TRACT ............... � <br /> ._.... . <br /> Owner's Name <br /> 0.� �...R th .erg................................ ............................... ..... ............Phone 6 ." .9.97..:.... <br /> 4 Address 18 2 thT Zia rd r� Wa <br /> .--... ...:. = ----------Way <br /> ------ <br /> City Stl p...._..... ............... <br /> E Contractor's Name ...B1.q.ck.ard's Sep; is Tank License # 268 51 � �8 <br /> .... . -- .............••-......_ • -... Phone _. 63tr.7Q.... <br /> Installation will serve:---- Residence-E)Apartment-House.0—Com mercial❑Trailer Court ❑ � <br /> Motel ❑Other .__......... <br /> Number of living units:...9._ _ Number of bedrooms .....Garbage Grinder ..........__ Lot Size ..'0'X. <br /> Water Supply: Public System and name .....__.._.•---......................Q�tY_.....--..._-_ .........--Private ❑ <br /> Character of soil to a depth of 3 feet: Sand`s Silt❑ Clay ❑ . Peat❑ Sandy Loam {] Clay Loam ❑ <br /> Hardpan EJ Adobe a Fill Material ............ If yes, type --- '--:-_------- _- _.-•- <br /> IF (Plot plan, showing size of lot, location of. system in relation to wells, <br /> Y ` buildings, etc.#rnust'beRplaced on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available.within 200 feet,} <br /> PACKAGE TREATMENT <br /> j ] SEPTIC TANK ] Size--------- X1°X j! 4 --------•--...... Liquid Depth ........�:8......--- --� <br /> Capacity ---z�?00 Type sq':' -Material <br /> ....Concre.�eNo. . Compartments p _2.................•6 <br /> Distance to nearest: Well _--��•- ---w:- •y___--,Foundation ..___lal .. <br /> .....__._ Prop. Line .. _ <br /> ?.. <br /> LEACHING LINE []I No. of mines....1-----•-----_----- Length of each line.---.8.0-1..... ......... Tota! Length ......50.'­ rn <br /> "D'-Box-" ..._... Type Filter-Material ...........`.. -• 19'� <br /> ..Depth Filter Material ............................................ <br /> *t IJistance to nearest: Well ._--.�.•�.-....... Foundation .......:5�...._._.. Property Lined ........I------•- <br /> SEEPAGE PIT ti[x) It <br /> 25-'•- - " ` <br /> Diameter ___-..--�J 8... Number ..._...,.1._-_--��-:...... Rock Filled Yes ® No I <br /> �. ' ,Water.-Table Depth ----• 90---= = -- ....... Rork Size 2 s <br /> " Distance to nearest: Well ......_"-------------------------------Foundation 1Q ....... Prop. Line J�.................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ........... ................. <br /> 7.Septic Tank (Specify Requirements) .._____.....1200 gal. <br /> ----......................... <br /> - <br /> Disposal Field (Specify Requirements) ....... .' tach-, Y1e & Pik-__4P"X2 ' <br /> - ....................----..... <br /> "I <br /> ''"` <br /> ------------• •---------------••- -------------------------------------.............................................................. ......-•-•••---•. ......... <br /> t I c (Draw existing and required addition on reverse side) <br /> 1 hereby certify,that I have prepared this application and that the work will be done in accordance with San .Joaquin <br /> .,County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcm <br /> sed agents signature certifies the following: <br /> "I'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 /> ! <br /> Signed -------- �.�k......... Owner <br /> BYI• ------!..... . ............. .....................-•---- .Title --••----....Contrac.tQr........_...:.:........_ <br /> (If other than owner] .......... { <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...- •_--•-- •-- DATE .. r...._.. _.�.."._ _ _ <br /> BUILDING PERMIT ISSUED ....... .............. ... .._............DATE _.._......ADDITIONAL COMMENTS ................. .................................. ............................................................... I <br /> •---•-•----- ........ ........................................................... •.... <br /> ..........--------- ....... . .......................... -----_-.-.-...... ----------------- <br /> - •-.------•-•-•-----....------- <br /> ---------------------- . . ................._Final Inspection by •- .. . <br /> .Date .... ......... <br /> SAN'JOA UIN LOCAL HEALTH DISTRICT <br /> E. H_13 241.SAA Qo., 4AA <br />