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FOS oFl=icy USE: APPLICATION FOR SANITATION PERMIT- <br /> w <br /> . Permit No. .__ ..... <br /> {Complete in Triplicate) . ...... <br /> This Permit Expires I Year From Date Issued ' Date Issued .................... <br /> ................................j_ , <br /> Applicafion 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 Regulotions: <br /> JOB ADDRESS/LOCATION ..Morada Mobii:e Park,. 2484._N. 99 Hiway ....CENSUS TRACT ------------------- <br /> .... ••....... <br /> . ........... .._._ <br /> Owner's Name ---Roy...and Arlin Teekel 931 0X97 <br /> . ..............:. ..........Phone ... ......--• 's <br /> Address #-.6--Lindberg Dr. San Jose Cad ifornia <br /> -----------------------------------------------------........-•.............city -- n ---.....--------•----- <br /> 66 0 <br /> Contractor's Name •A• awls Oris, Inc. ..License # _ 100511 Phone 4 96 7 <br /> ................... -- <br /> Installation will serve: Residence❑Apartment:House❑ Commercial Efraller Court ❑ <br /> Motel❑Other.._---•-------- --------•-......_ ........ <br /> Number of living units------------- Number of bedrooms ----------..Garbage Grinder ............ Lot Size ...................................... <br /> 4 <br /> Water Supply: Public System and name :: �''` . ..................... <br /> -----••-------...-••-•-_.... ............ ...... <br /> .............................. _ ......Private❑- <br /> Character of soil to o depth of 3 feet: Sand.❑ Silt[ Clay X) Peat❑ Sandy loam.o Clay loam <br /> Hardpan[) Adobe M Fill Material ............. If yes,type............... ............ <br /> (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEIN INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i <br /> PACKAGE TREATMENT [ l SEPTIC TANK I ] Size.....-.......................................... Liquid Depth ...---------------- <br /> Capacity ------------ <br /> ------------ i <br /> Capacity ._ No. Compartments <br /> _ Material...................... ' <br /> Distance. to nearest: Well .....-...____--------.__-•.........Foundation ...................... Prop. bine --------------- ........r <br /> LEACHING LINE [ J No. of Lines ------------------------ Length of each line........................ ... Total Length <br /> 'D' Box ............ Type Filter Material --------------------Depth Filter Material ............................................ <br /> Distance to nearest: Well .................. Foundation __........._ ........... Property Line ........................ <br /> SEEPAGE PIT Depth ...___25-... -.. Diameter --��"-•---. Number ....�Z�_____•-----___--- Rock Filled Yes Na ' <br /> ❑ ; <br /> Water Table Depth ------�P................ <br /> •-------•-•----_--..hock Size . f'--------2n------••--- I <br /> Distance to nearest: Well ........................................Foundation ..9q, ........... Prop. Line --- �-._.._.--- <br /> REPAIR/ADDITION(Prev. Sanitation Permit ----_------------- ................. Date ...............-.---------•------_) <br /> Septic Tank (Specify Requirements) .......................... ..........�------.....,--.-----... -----------................... <br /> .............. k <br /> A rox. 16X48 X dee polishing and and (2) 4811 <br /> Disposal Field (Specify Requirements) .............................•-•---- -•--••-------••--•-----...--------._.........---••----------------•-- ------- <br /> -_._PUs.,--..(,2.)....jet_ Aerators, control box with valves, necessary connections and <br /> ----------•--- -•..._......--••-•-----•.................................................. <br /> ----clean--u_n•---(se_e...att.aclaed_..arawa.ng._for. 1aYQut and discr ,pt on of alterations).. <br /> ­.1 <br /> existing and required addition on reverse side) - <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ) <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Hence owner or licen- <br /> sed agents signature certifies the following: i <br /> "I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -_.D.9 ._Parrish & Sons, Inc. <br /> 3 weer <br /> Mil es A. ' <br /> BY --- -- -- -- - Parrish -- into r.:_ <br /> (If other than owner} <br /> FOR DEPARTME <br /> NT USE ONLY <br /> APPLICATION ACCEPTED BY . -------------------------- ---. . DATE <br /> BUILDING PERMIT ISSUED ---------------- --------------- ---------------------------DATE ...... <br /> ADDITIONAL COMMENTS .._. ----------_----- .._... � <br /> ------•--....--- -- ----------------- ........... ---------------- -•-------- •------- <br /> -------------------•.......... <br /> -------------------- - - --- --- . <br /> t... _ .._.. <br /> Final Inspection by: ------------- - - ---- ----------- --- -- - � <br /> f"Z ..!!� <br /> EH 13 2,h1-6 f3 Nov. SAN .101�AQ-UiN LOCAL HEALTH-! DISTRICT 8/74 3M � <br /> C 4 <br /> z 75 � <br />