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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------------------------- ; Permit No. <br /> t G o (Complete in Triplicate)l <br /> ---- ------------------- ------------------------------ I=-f�� �� <br /> � Date lssued10:`AD__-k. <br /> ------------------------------- --- ---------------- This Permit Expires 1 Year From Date Issued <br /> Application isihereby 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 Na. 549 and existing Rules and Regulations: <br /> JOB ADDRESSILOCATIOth3 -�7-4r----Ze:0- QF/---'_�_: �L' � t� c� �: CENSUS TRACT <br /> Owner's Name ----f------ <br /> , --- <br /> -------- •--------- ---------------------- _....---- <br /> - <br /> Phone.- <br /> -- : f - �tY --------------------------------------------- .Address <br /> +. <br /> Contractor's Name 77/047 ;9 r--------------------------------- --------License # , ,.__ Phonea�o ------ <br /> Installation will serve: Residence 2Apartment House❑ Commercial [ITrailer Court 40 I ' <br /> Motel ❑ Other ------------------------------------------- <br /> Number of living, units:___�__� Number of bedrooms ._,�_.---Garbage Grinder _��'__ Lot Sze __/_�__-��`"�'-�_ <br /> --- - ----- ------------ <br /> Water Supply Public System an kname --------------------------------------------------------------------------------------------------------------Private E] <br /> Character of soil to a depth of-3 fee#:4 Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam.0 <br /> Hardpan 0 Adobe jo Fill Material ------------ If yes,type --------_----------------- <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_..(NNoseptic tank or seepage pit permitted if public sewer is available within 200 feet,) C� <br /> PACKAGE TRiATMENT ( ] SEPTIC TANKSize-----------------------------------------_-----_ Liquid Depth -------------.....--------- <br /> CapaitYTMYPe ------ Material No. Compartments = <br /> I <br /> Dista nce to nearest. 1Ne11 _ y______th>offt_k_e__ach <br /> ___ Foundation ____________________ Prop. Line ______________________ <br /> E I No of Lines ________--------___ _ Leri line-- ----._ _ Total Len th _L ACHING L N� [ l � 9 � � --------------- 9 --------------------------- <br /> D' Box Type Fil#er Material <br /> w <br /> yp i- E h Filter Material <br /> Distance to nearest: Well ------ __-._ Founda` rt--------------------------------------- <br /> ------------ <br /> ine--'----------------------- <br /> 4 <br /> -------- thin `, - Property Line= _=� _=___— -- J <br /> SEEPAGE PITC } Depth _ N <br /> ------------------ Diameter -------_._-.__-- NumbeI ---------------------------- Rock Filled Yes No <br /> Water Table Depth --- --------------- ---------------- _ -R k Size -------------------------------- <br /> I Distance to nearest: Well ___________ ________________ ______ oundation Prop. Line _ _____ <br /> ----------------- ------------- <br /> s ; ateP`:---------- --------) ' <br /> �- <br /> RESA IR cA aD k ION cRfe Re au rement Permit�r Ila,-'c¢' dam <br /> P { ( P Y q ) <br /> Disposal Field {Specify Requirements) -----------------------f----- ----- ---- - k I <br /> --------------------------------------- -- --------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> II (Draw existing and required addition on reverse side) ! . , <br /> I hereby certify that I have prepared this application and that the work will beidone in accardancefwith San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen= <br />