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FOR OFFICE USE: k C,ca r6L. rO <br /> 1 , <br /> APPLICATION RSA I,PATION PERMIT C <br /> ,..,[Conepletotn_1'ripiicatal .. Permit No�fR...-•!o/-- <br /> Date Issued/(-IA._-_74. <br /> ....... ................................ This PermltExpires t Year From Dahlssued <br /> Application is hereby made to the San Joa kiln Local Health District for a permit to construct and install the work herein <br /> describe]j T 's icatia 'n County Ordinance No. 5,49 and existing Rules and Regulations: <br /> JOB ADQI2 S <br /> L. OCATION _."._ .. .- _--- ... <br /> ! TRA <br /> Owner's Name X......... - ----- •• -_ --•- r ---- <br /> • <br /> i <br /> . Address � , �...._ .. one ................ <br /> •--•---••-----•----- <br /> ; Q._�..... .....Clty .............f...._.--�--•• _...... ................................ <br /> Contractor's Name - License ih Phone <br /> ASIA_-YI-�..t -----.._. <br /> Installation will serve:,-- Residence A artment House 0 Commercial <br /> oTraiier Court Ej , <br /> Motel ❑Other................ .......................... <br /> �. NuMber of Iiving'units:G?M. __.._ Number of bedroo s _._.._..__..Garbe Grinder <br /> Lot Size <br /> j Water Supply: Public System and name ...... s��.:--- .............. 'vate� <br /> i <br /> f Character of soil to a depth of 3 feet: Sand Silt Clay Peat <br /> ❑ Y ❑ y Loam ] Clay Loam <br /> :Hardpan [Q Adobe 0 Fill Material ............If ,tYp <br /> es a............... .........:.. <br /> Y <br /> (Plot plan, showing size of lot, location of system in relation ,to wells, buildings, etc. must be placed on reverse bide.) <br /> NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ) SEPTIC TANK I ] Size...... .... Liquid Depth _. ....... <br /> G r Capacity •••. Type ---- aterlali tlf_k No. Compartments �}1 <br /> Distance.to nearest: Well -__•..............................:.Foundatlon <br /> t <br /> . •-----•-- Prop. Line ...................... <br /> LEACHING LINE [ �No. of Lines ---------- ...... Length of eachline. ........... Total Length ...--_..__....- - -__-__-_. V <br /> �. <br /> D' Box ___..__.___ Type Filter Materia( .........:....:.....Depth Filter Material <br /> I <br /> ri <br /> 'Distance to-nearest: Wel! <br /> ... Foundation 9 <br /> ....................• .._.......__. Property Line •--•----•---------• <br /> SEEPAGE PIT [ <br /> Depth -------------------- Diameter .........:....... Number ............................ <br /> Rock Filled Yes 0 No <br /> Water Table Depth Rock�Size` ............... <br /> ............ <br /> Distance to nearest: Well <br /> .................... __:_..........Foundation .................... Prop. Line ..............,....... <br /> REPAIR/ADDITION'(Prev. Sanitation Permit :................. ....... Date . <br /> Septic,Tank {Specify Requirements} . j I^ <br /> Disp�osga Field (Specify R uirements) k f r <br /> -- , <br /> •-------. - � , <br /> -•---------- -••-------------------...•---......------------. . • - <br /> -•---•---:-•. ..................... <br /> (Draw eidsting and required addition on reverse side) i <br /> I hereby certify that I.have`prepared this applicaticn and that the work w_I _be,don*;jn_accordance-with..San Joaquin <br /> County Ordinance&; State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or liven- <br /> sed agents signature certifies the followings <br /> "I certify that in the performance of the work for which this permit pis issued, I $hail not employ any person in-such manner I <br /> as to become sub t Workm pe ' an laws of California." : <br /> Signed -------- <br /> 9 - Owner <br /> BY ----------------------------------------- ----- ---- -•------------••--- Title ......................................... <br /> h <br /> (if other than ownerl . <br /> - <br /> DEPARTMENT USE ONLY . <br /> . I <br /> APPLICATION ACCEPTED BY ._ ---:----- ..................... <br /> BUILDING PERMIT ISSUED . DATE....- " ... . .........: <br /> ----------- -----------------•---•••• --------•------.---•--- - DATE _...--•-- :.__._....:- <br /> ADDITIONAL COMMENTS ..... .. .... ... - - ' " <br /> .----•••---•-•` °------•-...,_-_.-----__-__-----------------------------• .....------------------ ................... <br /> ............1----------------------------I <br /> - - <br /> -------------4 <br /> -- --• --- - •......................••--- -•-- ------------------------------------ — --------------------------------------------- •---.. <br /> ----•---- ---------• ----------- ------ <br /> -- - ..............-:------ <br /> Final Inspection by: -•__-- -_,. • - � _ - --• ---•----- <br /> - -- -----------=----' ° .. ---•-------------------- ...................._Date ... -. -.- 7_ __ <br /> EH 13 2h 1-68 <br /> 5A JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N I <br /> E <br />