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FOA OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .�.,---------------------,------ <br /> [Complete in Triplicate) Permit No. 1--- -- <br /> ---------------------------------------------------------- <br /> ------------------ - This Permit Expires 1 Year From Date Issued Date Issued <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 /> JOIE A'DVRES!�/LOCATION 1-- - ', _ E _i`-I_f,�6._j�------------------------- TRACT _ -_-r ----.----- <br /> Owrie"1:s,NMme -------��r �----z-�-------- -� .C,._> .t`j1q-i d-- - -------------- Phone <br /> ?Address - -`. �'� ---------10 _ _t ------------------ -----. City --- �-`��}�-�-��f------- -------------------------------- <br /> R' Contractor's NameL'U__r____.3�-•.---------------------------t-------------------------------License # ---------:-------------- Phone -----------._.._._ ........... <br /> Installation;will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel [:] Othe� ! <br /> )- ---------------------------------------- I <br /> it �. <br /> g - ----' »t.g Grinder --- Lot Size r---A�_ 3.'1`�?6=----------------- <br /> Water Su I Public System and name _-_________ _____________ <br /> Sup Y• Y - --- ----- --------- } <br /> Number oflivingunits:_. ._._ � Number�,af bedrooms Garbo e <br /> + ___Private <br /> Character of soil to a depth of;3 feet: Sand`❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> .j.Hardpan ❑/ Adobe l]- Fill-Material , V12_-_-lf.yes,type -------3-------------------- <br /> (P'lot plan,.showing size of lot, location ofrsystem in relation to wells,"buildings; etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tarsor eepa it permitted if public s�er.is available within 200 feet,) ,r r <br /> ______ <br /> PACKAGE TREATMENT [ ] SPTIC'TANK Size____�� / _______ _� _. a p .___.___.. . l� <br /> Liquid Depth <br /> l Capacity/�_-00------ Type Compartments _--- <br /> istance to nearest: Well Length of each line --- 7 �� �. Prop. Line ._.:- <br /> i <br /> --------5-0---------------------Foundation <br /> r <br /> LEACHING LINE [ No. of Lines _______ ________ g _ __ � t_._:_____ Total Length ----.�K_�-�________.__.. q4 <br /> D' Box _ Type Filter Material f_ 4_ =.....Depth Filter <br /> 'Material .------- ______________________________ <br /> _ , <br /> Distance to nearest: Weil _--__. %__.= ---- Foundation ___I ;'-+--� -P-roperiy Line E..___._-......"__...... <br /> SEEPAGE PIT € ] Depth ____________________ Diameter ________________ Number _.--_____.__--.- -____ Rock Filled I.Yes ❑ No <br /> Wafer Table Depth Rock Size "--------------- ---• { <br /> I f � <br /> Distance to nearest: Well ________________________________________Foundation, -------------------- Prop. L)ne ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------- --------------------- <br /> ''Septic <br /> -_---------_''Septic Tank (Specify Requirements) --------- --------------------------------------------------------------- ---•---------------------------- -------------------------•- 3 <br /> Disposal Field (Specify Requirements) _1-.C:�,_�.___ - ---------------------------------------e____________.---------_-__-- <br /> i---------`------------------------='------------- ----------------------------------- ---------------------------- -- -------------------- <br /> - - -- ------------ --- <br /> ---- .. --------------------- <br /> "" W. ''"�` IlDraw exrsting�and-req'uired=addition on,reverse sidei4_ .— �t = <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 Joaquin LocaWHealth District. Hosie owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify/illa in/the performa ce,a the work fo which this permit is issued, I shalt not employ any person in such manner <br /> as to bec rr�'e s bject o Work an's Co ensu on laws of California." <br /> 4 �� Owner <br /> Signed rF <br /> BY --------------- ------------------------- --------------- _ .4 <br /> ------------------•---------- ---"-- -��- Title ---------------------;--------------------------------' <br /> ---------------- <br /> (If other than owner)_ . <br /> r..3 <br /> FOR DEPARTMENT USE ONLY <br /> -------------- <br /> APPLICATION ACCEPTED BY ------- ---- '- t- C / f <br /> -- • DATE _. . <br /> BUILDING PERMIT ISSUED ______.__­.._�.�._-_.,__-_-.._ •---- -----------•--DATE -------------•---•--•-•-- ----------- <br /> ADDITIONALCOMMENTS ------ ---- --------------------- -----------------=-=- --------- --------------------------------------------------- --------------------------- <br /> - <br /> ---------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------=.------ <br /> Final Inspection by: ------------ -------Date -- --------------------------------•------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />