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APPLICATION FOR SANITATION PERMIT <br /> x.. ...................... <br /> '6' I <br /> ..........I.............................................. lComplett In Triplicate) <br /> ......................I...............................I.... VMS PeDate Issued <br /> rmit EXPIr" I Year rrorn Date Issuot! <br /> Application Is hereby made to the Son Joaquin Local Health blstrid'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 Regulatlonst <br /> JOID ADDRESS/LOC ....................CENSUS TRACY .......................... <br /> Owner's Name . .. <br /> ........................................... ........."...-Phone ....----_-•- <br /> Address ............. ................CI* . ................................... . <br /> X........I.. ....... .................................................License Phone _V/a-b.:JY0i­ <br /> Contractor's No 07t-a—, <br /> Installation will serval Residence Nf Apartment House 0 Commercial(3Trollor Court 0 <br /> T1_ <br /> MotelEl Other.......... ................................ <br /> Number of living units:....___..... Number of bedrooms .....'.._..Garbage Grinder ............ Lot Size .... ......... <br /> Water SupplVz Public System and name ..................._..•-•------..- ..............----- ......... ............................._PrIvatett <br /> Character of soil to a depth of 3 feet: Sand 0 Silt E] Cloy 0 Pool 0 Sandy loam [J Clay kwm,�T <br /> Hardpan C] Adobe Fill M6terIaI_;..... , ................ <br /> 0 — , . If VO4type - <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed an reverse aldo.1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENTSEPTIC TANK <br /> X.e..........................� Liquid Depth Lf............ <br /> ............. <br /> Capacity Type No. Compartments <br /> Distance to nearest: Well. .....1(7 0........... .........Foundation......IA.'—...... Prop. Line..................... <br /> LEACHING LINE JA No. of Lines (I <br /> V Box Z*.......... ..I...... Length-of each .. ............ Total Length .1.72-............ <br /> A, <br /> ... . ... Type Filter MoterlO Depth Filter Material ........................... <br /> Distance to nearest, Well ..../Jmp........... Foundation ...../-Q..1--------- Property Lino ...-520............. <br /> .10 f <br /> SE PAGE PIT ......... Diameter . ....... Number ....................... <br /> Depth r Rock Filled Yes NO <br /> V_ tr, X, <br /> .0 V <br /> Water Table Depth ...................................................... .. ..„_.-,.........Rack Rock size <br /> 'Distance to nearest, Well .........In......................Foundation .... Prop. Line ..e-/. ---------- <br /> REPAIR/ADDITION(Prov. Sanitation Permit 0 ...............•........__........ `Date...................................I <br /> SepticTank (Specify Requirements) ...................................................................................­­................—............................. <br /> Disposal Field (Specify Requirements) ............................................................................................................ ....... ........ <br /> .................................... .................... ------I............. ......................­­­............ .............. <br /> . ...... .. ... <br /> ­--­---------- ...... ...i6raw.existing-and.required,add.Iti.a.n..a.t;;rev.arsa,.sl.do.)..:........­­­....-................ <br /> 1 hereby certify that I have prepared this ripplicallon and that the work will Roto alone In atcorJonco with Son Joaclult"t <br /> County Ordinances, Stole Laws, and Rules and Regulations of the Son Jouguln Local Health b1strict. "am* owner of llc4n-, <br /> sod agentz signature certifies the fallowilig. <br /> 401 certify that In the porformance of the work (of which this P*tmlt Is Issued, I tholl not employ any parson In such manner <br /> Of N become subject to Workman's Compensation laws of California.- <br /> Signed ............................ ....... ................... Owner <br /> by.................../. <br /> L. ...... ......... ........................__ Side .......... t....... <br /> �ifo�ther on nwnec) ...... ...... ............... <br /> F DEPARYMENT U$E ONLY <br /> ---- � .1.1......... ...... <br /> APPLICATION ACCEPTED BY ....... I <br /> _!....I ...:1 1 - <br /> DATE ....�- <br /> (WILDING PERMIT ISSUED..................................... ",*.*,­.­,­,'-'.'­....... .........DATE ... ......................... ............. <br /> ADDITIONAL COMMENTS . <br /> ......................................... -......................... <br /> ...........................I..............................1-1........................................ ............ ....... .....................I...............................I.......I......... <br /> ............. ................... <br /> .......... ....... ........*...... ....... ....... .... .......... <br /> ........... <br /> ............................. ............I ............I........... <br /> inal Inspection by. <br /> Mi 13 Ph nov. <br /> SAN JOAN UIN I.00AL lit-ALTI-I I)V_;1RICI' 81711 3M <br />