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=•r <br /> "OR OFFIC"c USE <br /> Y.. p-PLIC/ ION FOR SANITATION PERMIT <br /> i Permit No- 71:... <br /> v I (Complete in Triplicate) <br /> This Permit Expires 1 Year From DafP Issued <br /> Dote Issued <br /> ? Apphcotior. is hereby made to t:-ie San Joac;uln Local Health District for a permit to construct and install the work herein <br /> described. 'his applicotior. is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> t <br /> -i08 A.DDRES.VL^ ... <br /> vCATION �- 9 y CENSUS TRACT �. `�� <br /> .--• -- <br /> . <br /> Owner's Name J �',c' 'r Phone <br /> Ac'dre r` yv �✓ r' ! City <br /> Contrcctor's Nam.! license Phone <br /> Ins•ollotion will serve: Residence Ti Apartment House[j Commercial L)Trailer Court [ <br /> 3 Mctei 7 Other _ <br /> Nurnber of hvina un;ts: Ncrnber of bearcoms _._Garbage Grinder Lot Size <br /> 151 <br /> Witer Supply: Pubiic oystem and name _..-- __.. .. . .. ...-._ -._.___.....Private❑ <br /> y Cn•oracter of soil to a depth of 3 feet: Sand 7-1 Silt❑ Clay ❑ Peat 1 So., ly loam l] Clay U. om ❑ <br /> Hardpan ^ Adobe Fill Material If yes,type <br /> (Plot plan, showing size of lot location of system in relation to welli, buildings etc. must be placed on reverse side.) <br /> NEW INSTALLATIC_ (No septic tank or seepage_ pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREAT&• JT i I SEPTIC TANK,t 1, Size Li quid De th <br /> q P <br /> Capccity Type Material No. Compartments .......... <br /> Distcnce to nearest: Well _ F:undotion Prop. Line .............. NJ <br /> LEACHING LINE i No. cf Lines Length of e.ch line Total Length - . .. . _..-......_... <br /> D' Box Type Filter Material ..Depth Filter Vaterial . ........_....._...... ... <br /> Distance to nearest: Wel! Foundation Property Line .........._._........ <br /> . <br /> SEEPAGE PIT Depth Di^meter Numbe- Rock Filled Yes ❑ No Q �[ <br /> Water Tobe Depth Rock Size <br /> iA Distance to nacres': `.'•'ell ..Foundation Prop. Line <br /> REPAIR/ADDITION(Prev. Sonitotion Permit Date ) <br /> • Septic -ao�k !Spec;fy Recu.'rerr,ents; <br /> Disposal Fi,>i.-J !Specify Requirements; <br /> p ;Drciw ex!c•In,an-1 rectuired additicn on reverse side) <br /> j 1 hereby certify that I have prepared this application and that the work :will be done in accordance with San Joaquin <br /> County Ordinance:, State laws, and Ruies cr:d Regulations of the San Joaquin vocal Health District. Home owner or licen- <br /> sed agents signature certhci.c the foi:owing: <br /> "I certify that in the performance ^r the we,h for which this permit is issued, i sholl not P--ploy any person in such manner <br /> as to becerne subjec!)o Workglon:s Corn. -nso!ion !owcf California." <br /> } Sianed ����`r�",_� Owner <br /> FOR D_P,RTMENT USE ONL,' <br /> CCc°; DAT. <br /> DA 11 L <br /> ,y <br />