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FOR OFFICE USE .< APPLICATION FOR SANITATION PERMIT <br /> ----------------------------------------- Permit No. <br /> --,.,(Complete-in Triplicate) . —m. ; <br /> -------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued _.//_ _4:_7L <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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ? <br /> JOB ADDRESS/LOCATION .-_-_---__�k -Bi-abs,ra"--FLa.-__&_,_T_Qkay-_-Cnl-nnY----------------------CENSUS TRACT 375_-7.-._ _.---- � <br /> Phone._ I <br /> Owner's Name T�']..Val-1y---DeV-.-------------------------------------------------------------- ---=------- - �6b-©3-7b--- <br /> i 2.8-39-_E MaSn I <br /> Address -=------- --= ---- ------------------------------------------------ ------------ city -------S-tOr,k_tO_n------------------------------------------------ <br /> i � <br /> Contractor's Name -'Bl� r <br /> ckard, -I--,S-ep-• Ica---Tank---------------------------License# -----26-8-9-51--- Phone -463-7.048-------.- <br /> Installation will serve: Residence�] Apartment House,0 Commercial :❑Trailer Court ',❑ <br /> f ` . <br /> Motel ❑Other ------------------------------- <br /> Number of living units:__1-------- Number of bedrooms ----_3-----Garbage Grinder _ _ Lot Size -5---a-a es------------------------ <br /> Water <br /> -------------i_------_Water Supply: Public System and name ---------------------------------- ' ---------Private <br /> -- --- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;[] <br /> Hardpans Adobe 'R Fill Material ------------ If yes, type ---------------------------- <br /> (plot <br /> plan, <br /> -_-__-_.-__-----__-----(Plotplan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) off, <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT {J SEPTI CTANK [ J Size------ _'X 'X10_'--_.-.-------___ Liquid Depth -------48" w <br /> #' V31 ,Capacity _120.4-------- Type ---_-S-q.......... Material-------cemen.t No. Compartments ------2---------_: <br /> i Distance to nearest: Well <br /> # ��4 Foundation lQ' Prop. Line 50------ E <br /> 1 <br /> LEACHING LINE S No. <br /> 1�6of Lines --------?-------------- Length of each line---------&-'----------- Total Length :___- 1110.............. <br /> D' Box ------1---- Type Filter Material -------2!'____-�---Depth Filter Material ----__.__l +' ...... . ....... ... <br /> }--._ <br /> r -Distancew- <br /> to}nearest:Welh !__:____._--,Foundation -- - -- Property Lines _�-----------_--- ---- <br /> SEEPAGE <br /> PIT Depth ---------- Diameter ------kQ------ Number --------------- ----------- Rock Filled Yes ® No ❑ <br /> f <br /> a- Water Table Depth __ _ __ _--___ Q_1----------------------_Rock Size __--- ".................... <br /> Foundation .. 44 ' ° <br /> € Distance to nearest: WeII -------- Prop. Line . 3 Q ---------- <br /> REPAIR/ADDITION <br /> ' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _______ ________________________________ Date ------------ --------------------- <br /> C <br /> 1 <br /> }t C ! <br /> Septic Tank {Specify Requirements) `;`.1?0-0---gad— ---------------------------------------- - <br /> ,; <br /> Disposal Field (Specify Requirements) -13a�---Treks L-In-e -&---2-_Pits--49 X25-C-------------------------------•---•----------- <br /> i -------- <br /> � _ .-- ------------------------------------------------------- ----------------------------------------- <br /> -_---------------------------------a-------- <br /> s <br /> t <br /> ----------------------------------------- --------------------- ------------------------------- <br /> (Draw existinq and required addition on reverse side) <br /> I 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: Homeowner or licen- <br /> sed agents signature certifies the following: <br /> "1 certif that in the t �y <br /> y 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� f California." Y <br /> Signed ------ ----- 3 ` " Owner <br /> --- <br /> pit. <br /> Y <br /> F (If other than owner] �, ,! <br /> I FOR DEPARTMENT USI~ ONLY <br /> APPLICATION ACCEPTED BY <br /> ----------------- DATE --------- -----------t------- <br /> BUILD]NG 'PERMIT-ISSUED. ----- ----------------------------------------- -__. _-.,DATE ---:-.---------=--------------=--- '----- <br /> ADDLTIONALCOMMENTS ---------------------------------------------------------------------------------------------------I----------------------•------•---' <br /> t <br /> --------------------------------------------------------------- --- <br /> ------------------------------------ . <br /> -------------iia:---- ,. <br /> ,__T- y. __. __ .______�__ ___ ___. _____ ------------------- <br /> __ _______------- -- -_---------------- <br /> ----- _. <br /> --- <br /> "'"- ,.. _Date <br /> Final inspection by: � '�." j� "- ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.N. 9 1-'68 Rev. 5M <br />