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FOR OFFICE USE: r, v. 11,x' FOR OFFICE SE . <br /> ----- -------------- ----------------------------------- PLI Co0_ te nANiplArcaON PERMIT Permit No:�'��+7--'T <br /> ---------------------------------- <br /> Date Issued--____-c-,30-77 <br /> ------------------------ <br /> This Permit Expires 1 Year From Date Issued <br /> � '� k � <br /> Application is hereby made to the San Joaquin Local Health District for a`permit to construct and install the work herein described, <br /> This application is made in compliance with County rdinance o: 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LO"C'ATION�49--- = --- --- -- ------� - -----------------{---------..CENSUS R T ------------------------- <br /> -7 <br /> - --------- <br /> ------- <br /> + <br /> - --- <br /> PhOwner's Name- ---- -- ------ -a----------------- ---- ------------------------ on <br /> Address--` l r = --------------------------------- Zip <br /> Contractor's Name-..-----}_..� ----- <br /> _ c _____________ License #_ a.�l_/�____Phone_._-9-3��� >� r <br /> / - <br /> - . _ G..-- - <br /> Installation will serve: Residence Apartment House.❑ Cornmerciala Trailer Court ❑ <br /> ------------- ------- <br /> t- <br /> Number of living units_______________ Number of b droo❑ms.__._. Garbage Grinder---------- , J <br /> •�-••� �'�-'�-.�' a Motel ' Ot er_ - <br /> - - ------- - ----- - <br /> t <br /> . __• _ � ;. i Size - °��- ------ - --'�- - --------------------- - - <br /> tnlb MccS t roVlae w � {ld-rCe -------- <br /> Water Supply: Public System land name__W;S� ----- ________�__._ _ . __ _�^-,_ __.______.__ �. 1Ty±___ __ __� Private <br /> Character of soil to a depth of 3 feet: Sand L 'Silt❑ Clay ❑ Peat,[ Sandy Loam ❑ Clay Loam ❑ ( .t� <br /> Hardpan ❑f Adobe 0 Fill Material------.------If yes^type______------------------------- <br /> (Plot plan, showing 'size of lot, location of system in relation to wells, buildings,'etc. must be placed onreverse side.) r� <br /> NEW INSTALLATION: '(Nb septic tank or seepage--pit-permitted-if-public-sewer-is available within 200'feet,) <br /> PACKAGE TREATMENT- [ ] ' SEPTIC TANK ['] Size._=_."_C�_�___��_�__�_�__....__�----.--_- Liquid Depth � _-__� <br /> r Ca�acit B TYPQ Partments <br /> Di sante.� rest. W� el l-- - - ---Faen n__._t_. . _ ' WI <br /> . Material No. Com <br /> t ; \- �� <br /> � op Line <br /> Illy <br /> LEACH 444G'LINE. � ]-,..No. of Lines--------------l.------------ ren9fif each.line--.-----------�:- ' _ Total' Length ------ - ---------= <br /> `3 `�T a Filter Material_ ._ '`:_.De fh:Filter Maternal--_- r; r <br /> D' Box YP P <br /> nearest: Well--- _ _-__Foundatiorit_SKI `�'_ VPrO erV Line --- -- --_ _ <br /> Distance to �. v.` - �.- <br />---SEEPAGE PIT [ ] De th_ Diamete Number, 1 k Filled Yes j No <br /> p "[ <br /> i <br /> Water Table Depth------------------------------------------------------------Rock,Size ---- ----- ------------------' 'r <br /> Distd'rice'to'nearest: Well°--------------------_.--__-_.-. __-__ Foundations.. ..7,!Z_.+n__.Prop. Line------------ --_--' { <br /> REPAIR/ADDITION (Prev. Sanitation~Permit# :" ' __--.Date <br /> -=_- ---------- - -- "_. ----------- ------------------------- <br /> Septic <br /> --------------`---------Se tic Tank (Specify ---- ------ ------------ )---- -----------------------'a <br /> ---' <br /> Disposal <br /> Field(Specify Requirements)_------------------- -i- ----------------- -------------------------- ---------- ------------------- ----- ---------------------------- <br /> s j .-+� <br /> ___________________ .-_---- __--- --------------- <br /> --._ _-.._------_ ____._____._________ __ _____ ________ ___ _ ____.._.__ - - <br /> 7-------------------------------------------------------------------------------------- _--" _ - , _ <br /> (Draw existing and required addition orireverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances,' State Laws, and Rules and Regulations of.the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: t <br /> "I certify that in the performance of'the work for which this permit is issued, -1 shall not employ any person in such manner as <br /> to become subject.to Workman's Compe tion laws of California." <br /> Signed------ -=- ---- --------- -- `-----=--- -=---- ------ ---- ------ = --Owner : <br /> BY------------ - ------ --- - -- --- -•- - -- ------Title------ ---- --------------------------------------------- ----------- <br /> f <br /> ----- --- F <br /> # (If of er th�owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------ -------=---------_----- - DATE.;.- 3Q 7 <br /> DIVISION OF LAND NUMBER.- ---- ;- -------------.--------------- ------------------------------.----.DATE ' .: s-- <br /> ADDITIONAL COMMENTS - ------------------`-------------- --•---------------;------ ---- <br /> ------------------- ----------------- <br /> t <br /> ----------------------------------------------------- _-------------------------------------- ----- ------ ---------------------- ------------------------------------- <br /> -----------a <br /> -------------------------------------- -- - -- ---- ----- <br /> Final Inspection b -- ---- = = ' " - `=------------=- -------- - ------------ Date = --------------- <br /> 1� Y---- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras 21 ft 7/76 3M <br />