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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> ....................................s-............... it (Complete in TrIsplicatt) Permit, No. ...... <br /> . <br /> k This rmit Expires I Year From Date Issued Dote Issued ... <br /> . ............................................... <br /> Application is hereby made to tl;e WT.Ioc4tiln Local Heoltli'Dlstrlct'for a permit to construct and install the work herein <br /> described.This application is made in cor :111an; ith Courity Ordnance 0 <br /> 7/di...once N . 549 and existing Rules and Regulations. <br /> *..*......................................CENSUS TRACY <br /> ........................ <br /> JOB ADORMAOCATION ...74 <br /> . .. <br /> Owner's Name ...... . ....Phone ......................... <br /> ..................y........_..._....-......... ..... ..... ..... <br /> Address <br /> ............................... <br /> ..........................I................ city sl;vroslel <br /> P <br /> 110 V 0j?.. <br /> P 000 .....................................License Lidense # <br /> Installation will servet R*Wdwx*AApartrneW House 0 Commwdal{Trailer Court . e <br /> Metel[:)Other............. ........................... <br /> Number of living units:. Wrnber of bedrimm Grinder ZW.. Lot Size :...._.M.. <br /> ......... <br /> Water Supply: Public System and riarne ......-.1...............................................................................................PrIvatold <br /> Character of soil to a depth of 3 feett SOW El, ,Silt E3, -Clay 0 "Pedje "Sandy Loam"16 Clay Loom 0 <br /> Hardpan 0 Adobe E] Fill Material ... ........if ye;,type,!.. ...................... <br /> (Plot plan, showing size of lot, iccotion of system In relation to wells, buildings, etc. must be placed on reverse side,) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public seweris available within 200 feetJ <br /> PACKAGE TREATMENT j ) SEPTIC TANK pize ............ Liquid Depth .................. <br /> CopocitylW___ Typ Material&40_�...... No. Compartments <br /> ------------------- ... . <br /> Distance to nearest. Well _.... .r.--.----------------Foundation ;Z ... .. Prop. <br /> 1 <br /> LEACHING LINE No. of Lines ....... Length of each I i n e.. ................­ Total Length /40*1. .............. <br /> 'D' Box Type Filter Material AWA-16.Depth Filter Material 14ft............ <br /> Dista /etAo4neorest. Well ....pr ........... foundation ............... Prop" Una <br /> SEEPAGE PIT I Depth Diameter .............». Number <br /> .... ­­ Rock Filled Y" 0 No Od <br /> Water Table Depth ...... .......................................Rock ............. <br /> Distance to nearest: Well .....................................Foundation .................. Prop. Line ...._............_..._.+4 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................................... .....I Data <br /> SepticTank (Specify Requirements) ..................................................................................................... ............... <br /> Disposal. Field (Specify Requirements) ...................................................,...._».... .... ...... <br /> .. . :...... <br /> ... .. <br /> ..... ........Z..... ... ................... ..........­­.......... ........,..,.........»...,»...__.»........... <br /> *...... ... .........I. ... <br /> ......................_........''r .......... <br /> ......................­­.............................. ................... <br /> JDrow existing and required addition on reverse side) <br /> II hereby ctr)iq that I have prepared this application and that the work will be done in ciccordance with Saft'Joaquin <br /> County Ordinonce*;­S1ate,-Laws,­and Rules and Regulations of the Son Joaquin Local Health District. Horn* ovam or ficen- <br /> sed agents signature t4Wsfies the fciilo�vinq. <br /> "I certify the" In tit* performance of It.hework'for which this pormit is Issued, I shall not employ any person In smanner <br /> as to become subject to Workman's Compensation laws.of California." -- <br /> Signed ..... Owner <br /> .............................. <br /> *................ .. ...............­­'­­ %V <br /> By. ........_..........................Title <br /> FOR DEPARTMENT USE ONLY <br /> 0 <br /> y <br /> APPLICATION ACCEPTED .....__.,....._.._.....»......_..,,....... .,. <br /> .... ................ <br /> .. <br /> BUILDING PERMIT ISSUED.... ....... 1 .. <br /> ..............je. ..........;.................... ........... ............ "DATE .. <br /> .......,..MATE.,...................................... <br /> ADDITIONAL COMMENTS..........-A................................... ......................................................................... <br /> ............................ ...................I.....................................:......................................................................... <br /> 4 ......................... <br /> ...... . <br /> -—------------ <br /> ........ ..... <br /> ....---------***,,­­—,"­­_­"­'I"—,* ...Data'7 <br /> ..... ..7................. <br /> .................... ...................... .....,,...»,... ..... .... . ? <br /> aInspection bye ....................»......................................... <br /> SAN JOAQUN-LOCALHEALTH DISTIUCT <br /> F, H 13 24 I.-AR taw AAA 7/72 3 M <br />