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FOR OFFICE USE: (1'. <br /> APPLICATION FOR SANITATION PERMIT <br /> ----- -------------------------------------------------- 4 '- <br /> (Contplete in.Triplicate) Permit No. <br /> _______ This Permit Expires i Year From Date Issued 1' <br /> - -------- ----------- ---------- --------- - Date Issued "/- <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 /> JOB ADDRESS/LOCATION (9D ;;7- d?-S- c - <br /> r-'�'c'�-�� t ------`----------- -----CENSUS TRACT <br /> - <br /> Owner's Name ----- -------- -------- --•---------- <br /> C ��}-------------------------- -- -----Phone -V-637_`-7-7-7-,�-•---- <br /> Address <br /> V. -/ .�Il` t <br /> ------- Cit <br /> Contractor's Name ------------- -------•-- -------------- <br /> ------.License # <br /> Installation will serve: Residence KApartment House,❑ Commercial :[]Trailer Court <br /> Motel ❑Other <br /> --------------------------- <br /> Number of living units:___-- ---- Number of bedrooms ---_!__-_Garbage Grinder ------------- Lot Size W-- <br /> Water Supply: Public System and name ------------------------------------.__ _.__ <br /> ------ -------- _ Private 1 <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat 11Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe"'�F,ill Material ------------ Iftype,es 'v l <br /> Y ---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or k' ;seepage pit w <br /> permitted if public sewer is available within 200 feet;] <br /> PACKAGE TREATMENT [ SEPTIC TANK' - ------ �� <br /> ---=- ------- Liquid Depth 1`� ------------ <br /> Capacityl d - No. Compartments . <br /> p - TYPE_--- ---- -- ----- Material__ -0`w�. <br /> Distc�nce1to nearest: ,Well- ¢=____ �� _f "" " Foundation "____ _C7�______ Prop. Line __ ------r <br /> LEACHING LINE No. of Lines ---.___ <br /> _____ Length of a ch line_____ , _._-___""__ Total Length ___I-� d <br /> r- Aav <br /> 'D' Box -----!-:-�Type Filter.Material "_Depth Filter Material _______ `'," <br /> rest: Well _'�C7 r J <br /> Distance to nearest: ` <br /> y --- - ""--- _-- Foundation ------- Property Pro a Line <br /> SEEPAGE PIT De th "� r r —� <br /> p -_------ Diameter _ - " -- Number --------------------------- Rock Filled Yes ' No <br /> �~ f Water Table-Depth...,--- - R -_,= _ �// ri r/ <br /> - --•----Rock SizeI 2 <br />