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FOR OFE,;�F U,%E- <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------- ----- ----------- Permit No. ------- <br /> (Complete in Triplicate) <br /> ----------I---------------------------------------------- Date issued <br /> ------------- ------------------------------ This Permit Expires I Year From 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 /> des,cribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB --------F—------- <br /> - ------------------------------------CENSUS TRACT <br /> Owners Name ------ --------- VR__1_F— --------------------------- -------------------Phone <br /> Address ---------------------------- city -------FiE ----------------------------------- ----------- <br /> Contractor's Name __0W_49-F;-------- -------- _Ij ----:----------------------- ----------.License # ------------- ---------- Phone -- ------ <br /> Installation will serve: Residjifhce < rtmeln!-House,E] Commercial :E]Trdiler Court <br /> Motel [:1 Other ------------------------------------------- <br /> Number of living units:-----I---- Number of bedroom s,"• -Garbage Grinder 90_____ Lot Size -------------- <br /> Water Supply: Public System and name --------------------------------------------------------------­­---------------------------- ClayAoam "F❑ <br /> -------Private <br /> Character of soil to a depth of 3,feet'_ Sand'El Silt[j Clay E] Peat E] Sandy Loam <br /> Hardpan Er" Adobe-E-1 Fill Material If yes, type ---------------------------- <br /> .. Yam-�� �' S- ! �•���,.'_° c ,�� <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 seep pit permitted if public sewer is available within 200.feet) <br /> PACKAGE TREATMENT SEPTIC Size_.�;_XIO---X-------6------------ Liquid,,Depth <br /> No•. Compartments ------7�.... <br /> Capacity AAC---- Type &EWST material - <br /> Sr <br /> Distance to nearest: Well 7�---------."Founclation ----!7t- -,- Prop. Line -------- <br /> -- --------- -No <br /> LEACHING LINE .,-,­No, ofil-ines ------ �� gnthj ,of each- line'-- tal LengthI G <br /> R Kv-,-�---Depth-Fitter Material j <br /> `D' Box Type Filter Material - I Ili - -------- <br /> D I sta n c-e to nearest: Well Proper Line <br /> 00 Foundation Property - ------------ <br /> - - --------------- -------- ' <br /> "INC <br /> Rock Fill-ed YesNo (j <br /> ia ------ ---- <br /> SEEPAGE PIT -,'Pepth - -------- D Number <br /> Water Ta'bI6 Depth ------00----------- ---------------------Rock_Size <br /> 0 Prop. ----- ............. <br /> ,Distdncd to nedF�st6tW0Wt­___-/0V---------------- __�_.'___'_,'Foundati n - ----------- Line J <br /> REPAIR/ADDITION(Prev. San itation,'�rn -- -------- ------------- Date -------------------------�L <br /> ACK. <br /> Septic Tank {Specify ReqUli�6mlents)-------------------------------------- ------ ------ -----------------------------—----------------------­--- <br /> 7�'041- <br /> Disposal FOd '(Specify Requirement's] -J, T TWO _F__T- ---------------------------------- <br /> ------ __7_Kfi------6f <br /> oaf <br /> - ------------ <br /> --------- -- ------------------------ <br /> -- ----------------- <br /> Nb,-------- <br /> --------------- <br /> __A� 7 T, - ------------------------- - <br /> -------------- <br /> ---------------------------- ------------------------------------ ------------ -- ----- <br /> (Dra" W existing 6nd required additio-n"on�r9y6r6e side) <br /> J, <br /> - <br /> 1 hereby, certify that I have prepared t 'and his application-"nd-th"at, the work will' be done in C�Ccorcla <br /> nice with Son. Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the.Son Joaquin Lo'cal.Health bisteid. Home owner or ffie' n_­ <br /> sed agents signp. rcertifies the following: <br /> Pft 'h.cill..not ipmplo'y any person in such manner <br /> I this permit is issued, I s <br /> rma Ce <br /> as certify <br /> object pto W r of California." s3 r <br /> to ------------------- Ow , <br /> ner <br /> Signe <br /> By ------------------------------------------------------- ------------------------7 # 0L-------- Title ------------------------------------------------- `-' <br /> (If ofher than owner) <br /> ------ _. .--FOR-DEPARTMENT-USE <br /> APPLICATION ACCEPTED BY G, <br /> Ti , .7- 41 1 - C. -- ------------ DATE -----12 4.7 6 <br /> --------------:-------------------------------- <br /> BUILDING PERMIT-ISSUED----W-.------------------------------------------------ --DATE <br /> -- ------------------------ --------------- ------ <br /> ADDITIONALCOMMENTS ---- --- --------------- ------------------------------------------------------- -------------------------------------------------------------------------- <br /> ------------------ --------------- -- - -------------- --- ------------ -------------------------------------------------------------------------- ----------- <br /> ----------------- -- - ------------- - ------------------------------------ <br /> ----------------- --- --------------- -------- .... -------- <br /> ------------ --- --- --- - -- ----------------------------------------------------------- 2 ---- <br /> ----------------- - - --- --- -- ------------------ <br /> Final Inspecti ---- --------------------------------- --------- --Date ---- ------ -------V <br /> t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 'E. H. 9, 1-'68 Rev. 5M <br />