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FOR OFFICE USE: <br /> 7; nAPPLICATION FOR SANITATION PLAIT <br /> ------ ---------- -------------------------- ---- --- <br /> (Complete in Triplicate) ...... <br /> ...........­­........11...... ......... Oermit N9. <br /> --------------- ------------------------- o' CNE ate Issued .. <br /> This Permif-Eipires!] Year From <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 ---2S'13_2...... ...... .... ..CENSUS TRACT <br /> Owner's Name --------- *.K6.r\a)aR--- ................. ---- <br /> . ..-P1h14one <br /> ----------- <br /> ......------------ <br /> . ......FAddress ... ------ cy ------RDContractor's Name ....094N <br /> ------ ----- <br /> License # ---- ------- Phone .. .......... <br /> ------------ <br /> Installation will serve: Reside'n'c"e- Apartment HouseD Commercial []Trailer Go <br /> U- 71 -73-3 <br /> Mot?L 0 Othe� ---1I.-...... ----------­- 7 <br /> Number of living units:--- Number of bedrooms . .........Garbage Grind <br /> Lot Size ._&RE&C7.F......... <br /> Water Supply, Public System and name --------------- <br /> 1 ❑1 <br /> Character of soil to a depth of 3 feet: Sand' <br /> D Silt❑ Clay 0 Peat Sandy Loa r" Clay <br /> FLoom <br /> Hardpan 0 .-Adobe E:] Fill Material -1\149-.- If yes, tXpe ------- ------- <br /> (Plot-plan, showing size of lot, location of.systerri in relation to.wells, bui,ldings, etc. mist be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank t or-§e� if'pu, Ic <br /> 1p Rit permittedbl' sewer is available within 200 FeetJ L. <br /> PACKAGE TREATMENT SEPTIC TANK:[;�� Size., X-5 7—------------ Liquid Depth <br /> j 7-ic.;--------------- <br /> R "e-- I <br /> Capacity .... Type CDAfCj�F-.TEMaterialPA-F-C&-'97—No. Compartments ---- <br /> : 11 .1 .................. <br /> istance to nearest: .Well ......:t=----------Fo.yr,dation .129 Prop. Line ----57- <br /> LEACHING LINE [ No, of Lines .... <br /> ----------------- Lengfh"of each line: ---- Total Length .... -------- <br /> 4 <br /> 'Q' Box/V47:5-- Type Filter Material/. Filter Material ... <br /> ............................ <br /> our <br /> Distance to nearest. Well oundation ....... Property Line 14-7 <br /> F k ...*-------------- <br /> SEEPAGE PITDepth ..------------------. Diamet ---I------------ Number ................... Rock Filled Yes ❑ No (OD <br /> Water Table Depth .................. ............................Rock Size .................... <br /> ------------ <br /> Distance to nearest; Well .............. .. .....................Foundation ......._ Prop. Line ...... ............... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....................­ ...... ...... Date -------- ---------- <br /> jty RRequiremePTts) -------_-- <br /> pecl ..... <br /> --- -------------------- <br /> -----------------­­--------- - ---•--• <br /> -----­_­------- --- ----------------_--------------------------------- <br /> F <br /> Disposal Field (Specify Requirements) -----------lc-'6,.'�' ---------PiE7R.M. 17------t-------- -------_----------_--- <br /> ----------M,001L-F-------- -MME........ C.a,-r P ------ <br /> fi <br /> 49U.77 '7771- <br /> --------- .. ......... .......... <br /> I-sT_1 <br /> (Dra�;exi7si'ng�and required addition on reverse side) <br /> I I have prepared this application and that the work will be done in accordance with So <br /> n Joaquin <br /> County Ordinances, State Laws, pri the San -.16tiquin Loe6l Health District. Home owner or licen- <br /> sod agents si,nature certifies the following: `3 73 <br /> th <br /> "I certify th A rn,,,e p ormance of the work for which this permit is issued, I shall not employ a in such manner <br /> . subject <br /> ct ma s Cc <br /> as to h orkman's Com'pinsation Tows of California." <br /> �F <br /> Owner <br /> Sign4. Z�. .... ... :. .... <br /> 7 <br /> k � <br /> By _..... .. <br /> ............... .............. <br /> (If other than owner) ---------------- Title ... <br /> ---------- ..... ........ . .......... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..-...T:. <br /> ........................ -------------------------------- DATE ... .. . <br /> BUILDING PERMIT ISSUED ...._.. .. ........ <br /> DATE. . - <br /> •_4 ADDITIONAL COMMENTS ... . ...... <br /> :------------- <br /> . ................................ ................. ...... .......... . <br /> ................................ ...... ........... - ----- - -- ....... <br /> .............................. ...... .............. ----------- ------ <br /> .................. .----- ------------ ... ...P ....... ..... ............ .............. ...........­­­............. .................... ......1 Final Ins p.e c't'i on....Y": ------ -- -------- --------- <br /> .........._........ <br /> SAN JOAQUIN LOCAL 'HEALTH DISTRICT <br /> F! E. H. 9 1-'68 Rev. 5M <br />