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FOR OFFICE USE: <br /> APPLICATION,FOR JT <br /> TION PERMIT <br /> (Complete in Triplicate} Permit No: ._-y --; "7l <br /> ------------- <br /> This Permit Expires IeWar From Date Issued Date Issued -_S'�.�:-71r <br /> Application is hereby made to the San Joaquin Local Health District for a permit to const and install <br /> tall�the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION -_ ^' ° �- a� <br /> S -_- -------CENSUS TRACT --- ---------- <br /> Owner's Name _ -____ •" /� <br /> 0 <br /> --------------------------------------Phone 1°4V_L%6_ <br /> Address --4____-- - - City _ <br /> -------------•-•--- <br /> Contractor's Name _�__. _ <br /> will serve: Vii` Residence Apartment House Commerc als❑ ai�lleer C� Phone ------------_---------------- <br /> Installation <br /> ' � ❑ ourt ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> ------------------- - <br /> Number of living units:--_ `__-- Number of bedrooms -3 __Garbage Grinder ------------ Lot Size --- <br /> - ----- ----------------------_ <br /> Water Supply. Public System and name _.--____--_ _'A .1 <br /> --------- <br /> -------------------•------------------- - ---------------- - -PrivateXT <br /> Character of soil to a de)thof 3 feet: Sand'❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam;❑ q <br /> Hardpan ❑ Ado }I-Ma.erial ------------ If yes, type ---------------------- <br /> (Plot plan, showing size of lot, loc ion of system i __r cation o wells, buildings, etc, must be placed on reverse side.} <br /> NEW INSTALLATION. {No septic t : k or seepa p er ed ifspublic sewer is available within 200.feet,) <br /> PACKAGE TREATMENT ] SEPTI Size�i <br /> [ ] ze------------------------------------------------- Liquid Depth --; , <br /> Ca city .. �- T e Material-- No. Compartments [---_--.- _ <br /> P <br /> l Dist nce o n st: }.I--°`_�$�`�_ i. P i .- �._._.... <br /> C r - - --------•--------Foundation A ------------- Prop. Line -d� �- . <br /> LEACHING LINE ----•---- <br /> i[ ] No. f L es -- Length of each line_-- Total Length �_�__. .-•___- � <br /> g ®1-------- <br /> � � D' B ---------- TYPe Filter Material --------------- ( l <br /> 4 .--_-Depth Filter Material ----------- -- _- <br /> Distant o nearest; Wel! - O_+------------ Foundation -49.0 <br /> Property Line ©Qr l w <br /> SEEPAGE PITDepth -------------------- Diameter <br /> -- Number ------. ._ - ---- Rock Filled Yes E] No <br /> Water Table Depth ------------------------------------------------Rock Size <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line''-..----------_- <br /> PAIR ADDITION{Prev. Sanitation Permit# -------------- -- i <br /> ------- - --------- �---- Date -------------•----•----•----------) - <br /> Septic Tank (Specify Requirements) -----------------_.- <br /> -------------------------------------------------- <br /> Disposal Field ;)Specify Requirements) --------------- .1 <br /> ----------------------------------------------------------------- <br /> % <br /> --------------------------------------------------- <br /> ----------------------------- --------------------------- <br /> ------- - i -----•--------------------- ---------------------------------------- -----------•---------- <br /> t -------i-------------------- <br /> ---------- <br /> _ <br /> existing qired,. ddi <br /> tion on reverse side)I hereby certify that I have prepared this application andthat e <br /> work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations-of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: { 3 <br /> "I certify that in the performance of the work for which this <br /> permits issued 1 shall not employ an i <br /> as to beta b' t to Orli p Y y person in such manner , <br /> I n's Compe ation laws of California." <br /> Signed'-`-.. ---•- �... ,. .. .,,,,,.,r...•.. �.. --- Owner <br /> BY "--.•o..�...�,.... „ <br /> -- - ------ _ <br /> 1. <br /> — - <br /> -- -------- --- -- Title --------- <br /> - --- ------------------ ---------------- <br /> {If other than owner) ------- ---------------------------- <br /> FOR <br /> --------- -----------------FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY____ _____ ___________ <br /> BUILDING PERMIT ISSUED - ------- -------------------------------- DATE S o�b" a� <br /> - ---------------------- <br /> ----------- ------- --------------------- --------------------DATE -- ------------ <br /> DITIONAL COMMENTS -----` <br /> --------------------------------------- - ------ <br /> - ---------------------------------- <br /> --------------------------------------------------------------------•---- <br /> Final Inspection by: ------------------ <br /> f ---------------------------Date -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M �� <br />