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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -- ---------------- (Complete in Triplicate) Permit No. ...... <br /> ---------------------------- <br /> -------------------------------0------------:--------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San <br /> Joaquin Local Health District' for a permit t . construct and"i-hstall the work herein <br /> described. This application is made in compliance with County Ordinance No. 111090 and Regulations: <br /> J 9_�_ _. 'N <br /> ./nd existing Rules <br /> JOB ADDRESS/LOCATION ------- _571 <br /> f iz-91;(-----------------CENSUS TRACT ---------------- -------- <br /> Owner's Name ...... - t - <br /> -----�'EC)-RCIE—---------S-M-1-TH---------Ij----------------------------- <br /> i m., - --------Phone <br /> Address ---2-14------N6------ -F REA10-N.-T—----------- j er <br /> -------------------------- City ­MANTEC19--- <br /> ---------------- -------------------- <br /> Contractor's Name <br /> - --------------- -------------License.i�P ---------- <br /> --------MURPHY <br /> 11 -------------- Phone ------ <br /> Installation will serve: Residence CRApartment House-0 Commercial: Trailer Court ;El <br /> ----------------I <br /> �7 Motel Ej Other -- -- ---------- <br /> Number of living units:/---/_—Nurnber of beclroomsla_`_Z<__6ar Z1 <br /> ETS Lot Size <br /> bage Grinder ---- ---------------- <br /> ---------- <br /> Water Supply'. Public SnfBrn and name ------------------ ---- <br /> --------------------- -- ------------------i--------------------------------- ---------Private <br /> T <br /> Character of soil to a depth of 3 feet: Sand'E❑ St EClay E :Peat ESandy Loam <br /> X Clay Loam 0 i <br /> /V II Hardpan ❑ Adobe,E] Oil] Material If yes,type --------------------------- <br /> (Plot plan, showing size of lot, location of system in relation o <br /> wells, buildinig' s, etc! must be placed on rever(W"side.) <br /> NEW INSTALLATION.',% (No septic tank-or.�seepage pit permitted if public sewer�is available within 200 feetj <br /> PACKAGE TREATMENT,, ell VJO-X--S----------- ------- Liquid <br /> NT\,j I SEPTIC�NK'X Size---- Depth --- <br /> Capacity Type 1%j <br /> Material-CONCRET E No. Compartments ----72 ......... <br /> 1i Disidinc i \1 I <br /> 9 nearest: Well -------- -------------Fo`6riclation Prop. Line 14-- <br /> , ------ ------ ____!--------------- <br /> LEACHING LINE 'No. of L_ir-iis <br /> --------------- Length of each-li-n-e------- -------- Total Length ........ <br /> 'D' Box jp-e-Filt,�r <br /> 'T --_-_Depth �Filter Material ------- -------- <br /> 1;- -4- <br /> Distance to nearest: Well --------- ---------- Foundation --- -------------- Property Line <br /> F1 i-TF-R FED K7 ­---------- <br /> E Roy P Depth ---- 9---------- Diametyr jNxim-ler --------2=-- Rock Fill d Yes <br /> g . i 0 <br /> is 11 <br /> Water Table Dep -J------Rock Size <br /> th ------ ---------i---------------- ----2177 <br /> r <br /> oz <br /> cj- �5 �_27- <br /> - --------- Foundation :71�t---- Prop. <br /> Distance to nearest: Well ------ a <br /> -------- ------ --- Line ----- --------- <br /> REPAIR'/ADDItlONFPrwv. Sanitation Permit# ----------------- ------ j '0' <br /> - ----- Date ----------1 1--------------- <br /> Septic Tank'(S'peeify Requirements) --------------------------- f <br /> --------- ------------ <br /> ---------------------- ----- ---------- -:72:77:n----_---------------- ------- <br /> f <br /> Disposdll{ n-Fi6la-(Specify' Requirements) -------------------f: - ........ <br /> ------------------ <br /> ------------ --------- <br /> ---- ------------------------------------------------ --- <br /> ---------------------------------------------I----------------- - <br /> II " ____ ------------------------ 7-------- <br /> -------------------- -- ------------------------------I jrrr��_ ' _- - i <br /> ---------------------------- ---------- ... .........4............... . U, ; J------- <br /> (Draw existing and,-Fequire 1 2----------------------- <br /> d'addition on reverse side) <br /> 1 hereby certify that I have prepared this applIcS All <br /> �on and that-the-work,will-be.--done in aciordanie with San Joaquin <br /> County Ordinences, State Laws, and Rules and Regulations of the Son Joaquin Local Health Distdit.,Nome owner or licon- <br /> sed agents signature certifies.the following <br /> "I certify r that4h the p4�rforrrLarQ� of the work for" hl hth�j'-N ermit is isiViedt-Irstrall not employ a Y Ppismn such manner <br /> w ac s p <br /> - <br /> as to become-su jectW"fo or f I <br /> 'y!r S on laws of-.Cbiliforn <br /> Signed <br /> ---—------- --------- Owner - <br /> --------------------------- -------- title ------------------- <br /> - ------------------------------------------ ------- <br /> (if other h�an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION 'ACCEPTED BY <br /> BUILDING PERMIT ISSUED --------- ---- --------------------------------------------- DATE -------',? 23(_ 4-------- <br /> ----------------------- -------------------TF?�..o--------- -------------------------------- ---DATE ------- <br /> ADDITIONAL COMMENTS 'I-------- <br /> -----------------------1� ------------------------------- ----------------- -1-------- <br /> ---------- ------------------------------ ---------------------- -------------------- ----------------------------------------------- -------------- <br /> W---------- ----------------- <br /> -------------I-----="------------------------ ----------------------------------------------- ------------------------------------------------------------- <br /> H ---------------------------- <br /> --------- -------------- --------------------- <br /> ---------------------------------------------------- <br /> Final Inspectionl by: ----------- - <br /> Date __. -- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br /> A <br />