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FOR OFFICE USE: <br /> �� APPLICATION FOR SANITATION PERMIT <br /> F' 7C- 7v <br /> ----------- Permit No: <br /> (Complete in Triplicate) <br /> ---------- ---------------------------------------------- <br /> I This Permit Expires ] Year From bate Issued Date Issued <br /> ----------------- <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 in1compliance with County Ordinance No. 549 and existing,Rules and Regulations: , <br /> JOB ADDRESS/LOCATION .-- �__ __50, Mossdals --YF' at eastendof_Bx'id e-CENSUS TRACT ________________ <br /> Owner`s Name .--------------------MUrpby--Pacific--- omp4py--------------------- ------------Phone <br /> Address ----------------------------------P_,0,,_-Bax-•86,7-----------------:------------------------- City --------Y1aMte_C_aa--Cal.ifs0rni&--------------_------- <br /> Contractor's Name -----------------Parrish_&__ ons,--I tc.---------------.-----------License # ------1 - ---- Phone --$------ 1 6 607 <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial:❑Trailer Court ,❑ <br /> Motel ❑Other ---------Job offie ------------- <br /> 6 <br /> Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ------2_UreS-__________-_-_--.-___- ¢ <br /> Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private K] <br /> Character of soil to a depth of 3.feet: Ss,,.an_d,'❑, Si.lf❑. „Gay_F_. ,,Peat E] Sandy Loam [k Clay Loam :❑ <br /> Hardpan E) Adobe'❑ Fill Material ------------ If yes,type _______________________-___ <br /> l <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic:tank or seepage pit permitted if public sewer is available within 200 feet,] ' <br /> PACKAGE TREATMENT [ I SEPTIC TANK'Fq Size----------- x$-------------------------:--- Liquid Depth -----52;f_____________ <br /> capacity 1200 ai <br /> P tY - - --g--- *Type ---preoas-t_ Material------COnCrOt'D No. Compartments ---t;�rg-._...__: <br /> Distance to nearest: Well -_� 4__________________________Foundation ------ ------------ Prop: Line __-__ _._ <br /> 14 <br /> LEACHING LINE [$4 No. of Lines __KQ_(2_)___-___ Length of each line- g0__ _______--- __- Total Length ---IZ0 __ ________ ____' <br /> 'D' Box -X--- -- Type Filter�ls✓,latenal .......Depth Filter Material --------1-9 'I <br /> Distance to nearest:•Well ____get!�--------- Foundation -------- Property Line ___ --______________ ' . <br /> Y SEEPAGE PIT [ ] Depth ` <br /> ____________________ Diameter ---------------- Number -- --------- ------ ------- Rock Filled Yes ❑ No �❑ ' <br /> Water Table Depth ----"' _Rock Size -------------------- <br /> Distance to. nearest: Well.- -------------- -------------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit#____----------------------___r_ ,.__ --__ Date ---------------------------------- <br /> Septic <br /> ________--T--_---.-_-___-______-Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------=---------------------------------------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- i <br /> i y <br /> ------------------------------------------------------------------"--------------------------------------------- -_---------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I 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 !Joaq`uin Local Health District. Home owner or liven- <br /> sed agents signature certifies the following. <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 Compens 'on laws of California." i <br /> Parrish & Sons Signed <br /> ; ------ Owner <br /> B w ; <br /> Title --_ �_o_ <br /> (If other than owner) <br /> VFOnR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY 1�` J DATE __ �� �3ca --------- i <br /> BUILDING PERMIT ISSUED .--- DATE ---------- --------------------------------- <br /> AbDITIONALCOMMENTS -- --------------------------------------------------------------------------------------------------- ---------------------- --------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------- ----------------- --- - ---- --------------- --------------------1------------- <br /> ------------------------- -------- ------ ----- <br /> Final Inspection by: -� Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> -moi <br />