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Fe-P•O;FICE USE: <br /> u , , APPLICA'i IOIv FOR SANITATION 'ERM,IT <br /> • � Permit No. 77 . ....... <br /> ;Complete;n Triplicate) <br /> I Date Issued -:0 -�f 7t/ <br /> Th;A Permit Expires 1 Year From Date Issued <br /> Application is heresy mese a the Sen Jooe�,in Local Heolth District, for o pe,-mit 'o cons1ruet and install the work herein <br /> ! described. This opplicat;on is mode in compiicnce with County Ordinance No. 549 and elitisting Rules and Regulations: <br /> J08 ADDRESS/1pCATiON G`- ? ',r`' n tnr d . CENSUS TRACT .... . ................. <br /> . ..... .... <br /> Owner's Nome :: <br /> ��-�. illi:�� ....................... Phone ._. . .....r!}2j.Q......... <br /> Address Zr Tr^ . ... <br /> city ��t i C:, <br /> c__ License "'S: ^ <br /> Contractor's Nome =.i- ::_re. C •_F T »:._7.. Phone ...1:.6.�...Zab:°...... <br /> installution will serve: Residence"Apartment House Commercial;uTroilerCourt ❑ <br /> Motu ,_Otncr <br /> Number of iiv;ng units: x;; ] Nur„'aur of bedrooms . . ........Garbage Grinder Lot Size .. l -Acra............. <br /> it Water Supply: Public System and rcme . ................ ....................................Private in <br /> �,�. . r Character of soil to a depth of 3 feet: Sand C] Silt❑ Clay L Peat[i Sandy Loom CDClay Loam ❑ <br /> { Hardpan J Adobe❑ Fill Material ... ..... If yes,type......... ................. <br /> r <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. Must be plated on revere skis.) <br /> i ;-,.cW INSTALLATION: (No sept;c tank or seepage pit permitted if public sewer is avoila 1 within 200 feet,) <br /> ' PACKAGE TREATMENT ( ] SEPTIC TANK( ] Size......... .... ...... Liquid Depth ............... <br /> Capacity . . .. ..... Type ..... .............. Material..... ................ No. Comportments ........-.»--------- <br /> Distance to .iocrest: Well . . ............. .................Foundation ......1»............. Prop. Line ------------------_. <br /> i s <br /> LEACHING LINJ n'J No. of Lines i . . length of each line _.aQ.'... ....... Total Length .....90................».. <br /> Depth Filter Material ............19"...... _ <br /> •D' Box1 .... Type Filter Material ......1;"...... --- <br /> { ; Distance to ......... <br /> nearest: Well ............... Founcation ...... .5........... Property Line ........................ <br /> ,.�; a• 1 <br /> ,. SEEPAGE PIT ( j Depth Diameter ................ Number ..... .................. Rock Filled Yes ❑ No G(—,u <br /> y <br /> Water Table Depth ... ............................................Rock Size ......... ....................Distance to nearest: Well Foundation ................... Prop. Line ......... <br /> ---•- <br /> ��� REPAIR/ADDITION(Prov. Sanitation Porm;t# ........ Data ........s'L)Zr »72.......) <br /> t .._................ <br /> �•.r�:��,; Septic Tc.:.. ;Specify Requirement:.) . _ ......... ................................................................................................ <br /> 0' Leacri Li.nc.................................. ....... ..................................... <br /> Disposal Fie lo (Specify Requirement. ..... .......................... <br /> ........................ ........ ............................................. -.. <br /> 3ryi' ct ..................... .................................................... <br /> ,ir { ...................................... ....... .. ._ .. . .. ... <br /> ;�. (Draw.exexisting and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be dune in accordance wills Sat <br /> JOGQWN <br /> County Ordinances, Sta•.t Laws, and Rules and Regulations of the San Joaquin Local Health District.Horse ewwer or haat <br /> r sed agents signature certifies the following. <br /> "I certify that in the performance of the work for which this permit is maived, 1 shall not eltlplay any penal in such awmar <br /> as to become subject to Workman's Compensation laws of California." <br /> a .t J ` <br /> Owner <br /> �ontr..q�or....... ... ... <br /> ................. <br /> By . �� Title . <br /> tY i, <br /> (if other than owner! <br /> Z'`• FOR DEPARTMENT SEONLY <br /> , ` <br /> DA <br /> APPLICA'ION ACCEP"ED BY <br /> . VIV) <br /> ' ! BUi_DiNG PERMIT ISSUED . ......... ... .. 141 ..... ...........DA <br /> ADDITIONAL COMMENT$ ... ...................... ............ . ........ <br /> _ :......................... ................................. .. ... .......... <br /> ..•. ...._... .) ..... .._ ...................... ...... . ....... <br /> C f y��,. .. Date I�Z7TJ.. <br /> a11., F,nal Inspection by: . . /" _'"J ../��'''' .. ..... <br /> " r „ ✓ <br /> ;AN .,OAC U:N :GCA. HEALTH DISTRICT <br />