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FOR OFFICE USE: <br /> APPLICATION POR"SQNITATION PERMIT � <br /> -------- ---- I (Complete-in Triplifatel ermit No-22-_Ir R <br /> -- ----- <br /> App 1�_--- - ;w --------------- <br /> --- ----- I This Permit Expires ] Year From Date Issued W <br /> -� - �-- - - - - Date Issued <br /> re <br /> � by <br /> wicati. is•,E.Ppli made to the San Joaquin Local with <br /> Coi Dis� t ""for"a p'a,it-lo co'n`struct-acrd-install-the-Mwork,-herein <br /> described. This�applEcation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ' <br /> JOB ADDRESS/LOCATION .- ._l X1,51_-_E._-.-MEtt--Hama -� <br /> Y ------------------------ --------------- --CENSUS TRACT s V'I r' <br /> Owner's Name ---J1M---MCCee-,` --------- ---- •------- <br /> Address <br /> 1/' 322 E Ma,in F -------Phone -.- 46-2x4.1-.0--= �--- <br /> ----------------------•------------- Cit <br /> Contractor's Name _-Jlackar.d_�_5-__S_eptic-_tank---_____--- ----------------------------- <br /> --- License # - . . - A63-?M. <br /> Installation will.serve: 2b - _ � - - --- Phone -- __---- _ �N <br /> Residence Ea Apartment House❑ Commercial :❑Trailer Court .0 <br /> Motel 0 Other - <br /> Num er of living unitsa---------- Number of bedrooms _-3.-__.lio_-Garbage Grinder ------------ Lot Size __--140Acres____ <br /> ii Wat it Supply: Public System and name ------------- <br /> ------------------------- <br /> ---- -----------------•----•------ ------------------ -- - -------.Private <br /> .Character of soil to a depth of 3 feet: Sand'[] Silt❑ Claya <br /> ❑ Peat❑ Sandy Loam j] Clay Loam E] <br /> Hardpan 0 Adobe'El Fill Material ------------ Ifes, a y <br /> y type --------- ---- ------ ------ � <br /> (plot plan showing size of lot, location of system in relation to waifs, uildin s, etc. mu ` <br /> NEW4INSTAL�ATION: g must be placed on reverse side.) <br /> {No"epti� tankor seepage pit permitted if public sewer is available within 200 feet,) f <br /> -PACKAGE 7 EATMENT ( ] SEP�IG TAMC i -------------------- / ~ <br /> i \ t,— � Size --X5-f-XIO--- Li uid Depth _ 1 !�"� {� <br /> q ----1.8 ------------- ! <br /> Capacityl 2 �Type --sq -------_ Material_ ` l r <br /> f 00nc-rete No.}-Gompartmer s -'---- ;-2_ <br /> �s <br /> Distance to nearest: Well sfl <br /> Foundation .--t--------- Prop. Line -----10-0= <br /> •LEACHING LINE ] No. of Lines - -2 � -� <br /> ---------------- Length of each 14--- 1-00-0 -___ _ Total Length <br /> n,�� ----200-k---- ..... <br /> D' Box -_---1._.- Type Filter MateriaF._.-?-f!.--__----_ De th Filter Material 1_ -" { f• <br /> ,.. . I p ----- 9 <br /> Distance to ;Barest: Well --- Q°------- -Foun anion �(}�! r ,+. <br /> ;SEEPAGE PIT <br /> f Property <br /> 1 Depth 25 ------ Diameter y .,. <br /> Numbed --- Rock Filled Yes [ No �• ` <br /> Water Table De th !_____ ._f <br /> }A �� -------•-=------. Rock Side -'r -------•------ } <br /> ) - <br /> J f Distance to nearest: Wel! ------------- r--------•------- !Foundation-110--co-4p• 104-- <br /> - -___ Pro Line ..- _ !_'_�__ 2� <br /> REPAIR ADDITION(Prev, Sanitation Permit# --------------- 4.* <br /> ______ } <br /> ---- Date ------` <br /> Septic Tank (Specify Requirements) -_ .-__ 1200 gal. I ! <br /> --- - <br /> Disposal Field {Specify Requirements} "' <br /> ------ ; <br /> 200 Leach-:Line -&--�_�----�3-�rX�-5'-- __�$�`-= <br /> ------ �. ---- <br /> - s <br /> _ s <br /> ----. ----------'------'------------------------•:-----------`---`- x`--`-----.----•----- <br /> ---------------- - } <br /> 21 <br /> (Draw existing and required addition on reverse side) r <br /> --------------- -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with"Son Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen- <br /> sed agents signature certifies the following: f <br /> "I certify that in the performance of the work for which this pern,iuis issued, I shall not employ any person In'Such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> # <br /> Signed - ----- -- ------ --- ------ I <br /> 1 d ------ -------- ----------------- -------- weer <br /> By ----1 --�- Title <br /> (If other than own4.7 <br /> er) i' ��� <br /> - =----------------- -- <br /> FOR .DEPARTMENT USE ONLY i -4 <br /> APPLICATION ACCE=PTED BY - <br /> ------ DATE ►----------.•-:- <br /> - ----------------------------- <br /> ADDIt IONAL COMMENTS --------------------- ------------------------------------------------------- <br /> ----- --=--------------DATE --- -------�- -------- <br /> ------ _-- - ---------------------------------------- --------------------------------------------------------------------- ------------------------- <br /> ----------------------------------------------------------- <br /> y. <br /> Final-'Ins-'Inspection b <br /> --- ---- ------- <br /> ---------------- --- <br /> � ------------- Date <br /> 4 _ SAN JOAQUIN LOCAL HEALTH <br /> E. H. 9 1-'68 Rev. 5M _ <br />