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<br /> FOR OFFICE US[--. ' FOR OFFICE USE:
<br /> APPLICATION FOR SANITATION PERMIT
<br /> x (Complete In Triplicate! Permit No.
<br /> �y
<br /> This rermit Expires i Year From Date Issued Datc Issued
<br /> Application is hereby madr,
<br /> This appfo ;)m ;,nn Joaquin Local Health DiEI�ict for a pnrmif to construct and Install the work herein described,
<br /> lication is made in compl;oncs with County Ordinance No. 549 and existing Rulrs and Regulations:
<br /> JOB ADDRESS/LO AT .y �/ tri✓�C � _ CENSUS TRACT
<br /> Owner's Name �}' 1�]e''z7 J��.ur ��11'.tx I.,;z� .. Phone/7f%' 3-3rC% ....
<br /> Address X 1 ),4- r;_ City C�"G:', '. Zip
<br /> Contractor's Name license '# 32e C Phone
<br /> Installation will serve: Residence[cj� Apartment House[] Commercial ] Trailer Court ❑
<br /> r Motel ❑ Other I
<br /> Number of living units: . . . ' Number of bedrooms ,- -Garbage Grir,det, ., - ..,Lot Size. ��:•.!l P 2C.[
<br /> Water Supply: Public System and name.. Private
<br /> s Character of soil to a depth cf 3 feet-,/Sand [] Silt[] Clov[] peat❑ Sandy Loam❑. Clay Loam❑
<br /> -� Hardman r, Adobe❑ Fili Material . . It y;s, type'
<br /> ;Sian, showing size of lar, la ;stinn of system in relation to wells, buildings,etc. must be placed on revcvse side.) -
<br /> Mt t NEW INSTALLATION: (No septic tunl- or seepage pit permitted if public s,-ver is'ovailanle within M feet,[ ./
<br /> PACKAGE TREATMENT [ j SEPTIC TANK /x/r � ;.r / Y �
<br /> / f� f5�ie� Liquid Death i
<br /> C:.pacity /C�d' T e_C✓?x c<r. Z ......
<br /> Type ... Material .,,,E'<7F-, .. - No, Compartments. _
<br /> Distance to nearest: Well . S ...foundation /C �. Prop. Line , T i
<br /> r / Length o each
<br /> I. . .
<br /> Ny
<br /> LEACHING LINE (� No. of Lines y �
<br /> • . f each line, ,...�C _Total Length ... fr�C-. .,.-,•
<br /> D' Box Type Filter Material.. ...?._K..-, Depth Filter Material . ..-.���...... •
<br /> Distance to nearest: Well .-. .Cc„'.,f .._. .Foundation . .J 0 .... ......Property line. .. ..
<br /> SEEPAGE PIT [►I Depth 7 ! t
<br /> Diameer . ��: .-, Number. . ..3., .
<br /> t �--�•— . ..-. Rock Filled Yes Na❑
<br /> '. Water Table Depth.. ..... .ty� -i
<br /> ..Rock Size..
<br /> Distnnce to nearest: Well �.,w c7 r Foundation., /.0%..'.. Prop, line ,
<br /> REPAIR/ADDITION (Prev, Sanitation Permittlt... .... ...... ........__Date..,..
<br /> Septic Tank (Sper,ify Requiremem.1
<br /> AV Disposal field (Specify Requirements)
<br /> ............................. .........................
<br /> ......................... ..... --................. ..............."..........
<br /> ...........
<br /> {Draw existing i
<br /> Q ��..- •quirtd addition on raverse side) �
<br /> f jti!+ I hereby certify !' JIsgtation and f)wt the work will be done in accordance with San Joaquin County
<br /> ' Ord!"ncmr, it- ,• f T-,,. c r:d Re uiaflont of the Son Jn.a M
<br /> uln Local Health District. moms owner or licensed a enH
<br /> S q
<br /> .slgn�tttre �t8fi-s •i;r fetl..wnr•a: g
<br /> "I certify that in th. pQ-form jt r;,e work fir wltlth 'nis Permit is Issued, I sha(I riot em le
<br /> to beeor»- •rtbteef •o It:'• .;,. ,s I-,n,p@ns0V" law of California." p Y on Y person In such manner as
<br /> It 9 Signed. ..
<br /> sy.. Titlr 'l7fl.� y' 1'
<br /> 0f cn n aN„ar}
<br /> FOR WN:ARTIWENT USE ONLY
<br /> APPLICATION ACC
<br /> . 8 7 .7
<br /> DIVISION"IF l.'+N:, o,,t,`Mf1ER DATE 717 . . . . ..-- - -
<br /> A IT101v..l COMMENTS DATE ' - • ••.•..
<br /> * .
<br /> Final Inspection by: fi• SAN JOAQU. .. ...
<br /> C ... .,. . LOCAL HEALTH DISTRICT .� Date
<br /> ras2,r•:ev. 7
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