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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />......................................................... Permit No. .._7��__-42/ Q <br /> (Complete in Triplicate) <br /> .................................................... This Perrrsit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here_in- <br /> described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations`: <br /> I <br /> JOB ADDRESS/LOCATION ..Sm.. .:. ..... .......... .. . . v ...4f _ .�._... �._��.CENSUS TRACT .•........._._..._--_-- i <br /> Owner's Name ....... . . ... . .... ....-• - ._..._..-- •------•-••---• � <br /> .. .Phone .................................... ; <br /> Address __....-- fU_ ... -- .. ............. ..... <br /> - - •........................... ........... <br /> ` 6 -g� 7 <br /> o <br /> Contractor's Name ...... _...�------- ...............---------License # .� ���_..... Phone ....................... ...... <br /> Installation will serve: Residence Q Apartment House 0 Commercial (]Traller Court 0 � <br /> Motel ❑Other ---------n&YO&L__ A—A" <br /> Number of living units:..--./..... Number of bedrooms ...2%.:.Garbage Grinder ............ Lot Size .._[? �✓............... <br /> Water Supply: Public System and name ___________________________________ ........ .........................................Private <br /> Character of soil to a depth of 3 feet: Sand U] .Silt C3 -Clay D .�. Peat❑ Sandy loam Q Clay Loam <br /> Hardpan [] AdobeFiII_Moterial __..__.___._ if yes,type ---•----------- ............ <br /> 1 ' <br /> A It \ (� <br /> (Plot plan, showing size of lot, location of. system in relation to .wells, buildings, etc. must be placed on reverse side.) \\I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted -if-public sewer is available within 200 feet,} <br /> Capacity �3#Tl- r rt�� ._ i `--�' Li <br /> SI, ..s`f <br /> Type M ' <br /> PACKAGE TREATMENT SEPTIC TANK $ize__.._... 1 ..__. :_.._ikv <br /> ateridl.. ._, No. Compartments <br /> Distance to nearest: Well .1W f \ [Foundation . ..19.. t ....... Prop. line <br /> LEACHING LINE No. of Lines --------__.............. Length of each line .:� ?..........._.._ Total length _Z��.._.. __.•_,_. <br /> 'D' Box ............ Type Filter Material ..9 .JDepth Filter Material .._•- -8-----------------------------•- <br /> r E', 11 �t <br /> Distance to nearest: Well ....__ ...... Foundation. .....(..a...fi ....... Property Line ... ................ <br /> r � U� 9 <br /> SEEPAGE PIT �Q Depth ....y ....-.... Diameter --3-3.. .__._ Number ........ ................... Rock Filled Yes � No <br /> Water Table Depth ..........................:Rack-Si xe-.4...C...fZ./1 <br /> Distance to nearest: Well .......l.Qa........................Foundation ;__��........... Prop. Line ....-.�.._.7`......... <br /> ti ; <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________________________ Date •......� : <br />