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r� <br /> (Complete in Triplicate) <br /> ..... ---- ---------------- " <br /> Date Issued -1-Q-7aZ,2-44 <br /> - <br /> -------------------_----------_---- ---- _._ ...... This Permit Expires 1 Year From 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 /> JOB ADDRESS/LOCATIO I51- ., ; .........CENSUS TRACT <br /> A j 1.. -- ----Phone /1lON�................. <br /> Owner's Name -- QN.r'�S vY f-. :f. !���L---���_;' - - I <br /> Address --------- <br /> _. f ----------.. City --' <br /> License # +'-------------------- Phone .n!Q nt E <br /> Contractor's Name ---OWN-�-R.----------------- <br /> Li :-------------- -- -- --•---- <br /> Installation will serve: Residence A artment Howe'❑ Commercial ❑Traller Court '❑ <br /> Motel E]Other . •----I--=---- - --- --- - -----•----------. <br /> N' <br /> 1 <br /> Number of living units-..-.---.__._ Number of bedrooms ._ -_;_,____Garbage Grinder ..__ Lot Size ----IJ_r__�._x_-.5�______________ <br /> Water Supply: Public System and name '-__Gl_- -_-v1JH-T -------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand M--`Silt❑ T Clay ❑ Peat❑ Sant y Loam ❑ Clay Locjm C1 <br /> Hardpan ❑' Adobei❑ Fill Material .N_0-:- If Yves, type <br /> {Plot plan, showing_size of-lot, location of system in. relation to wells, buildings, etc. must be plated on reverse side.} <br /> NEW INSTALLATION: (No septic Unk or seepage pit permitted iif ubli's er s a I ailable within200feet,) <br /> PACKAGE TREATMENT { 1, l SEPTIC TANK P ,5ize___. /YL_.... q p <br /> Z------- <br /> Capacity f;Z4 0----_ type C_HE, SrMateria1.C.0.t'd =__ No. Compartments ..__-171 ..._. <br /> QU Foundation <br /> Distance to nearest: Well .----- !`- -J----- ------ Com.----._. Prop. Line _---5 _---- <br /> lo <br /> LEACHING LINE [ ] No. of Lines -----2----2-------- LeHgth!of each line--------62- .--------- Total Length :----��0-_........_ <br /> y u Tc <br /> 'D' Box T- S-- Type Filter Mat�rilat _&Q.C_f�---Depth Filter Material --------1 q---------------------- <br /> -------- <br /> Distance to nearest: Well ----- - h:_.____ Foundation _-__.___./0-__..___ Property Line -._.S ------ <br /> SEEPAGE PIT [ ) Depth -------------------- Diameter ---------------- Number -------------.-------.------ Rock Filled,, Yes ❑ No C] <br /> Water Table Depth ------•------------------- ------------- Rock Size -------------------------------- <br /> Distance <br /> ------------------ •---------Distance to nearest: Well ----------------------------------------Foundation -_........--.. ... Prop: Line ...................,-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date . ----.-------------•-------------) , <br /> 1 1 \ 1 <br /> Septic Tank (Specify Requirements} --------------------------- -------------------------------- <br /> -------•------- ----------------------------- ---- --------------- <br /> Disposal Field (Specify Requirements) -------------------------- ------------------------------L----------------------------------- ------- -------------------------- <br /> ---------------------- ------ --- -----------------=------------------------------------------------- ------------ --------------- -------------- ------------------------ <br /> (Draw existing and required addition on reverse side) <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 Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in th performance of the work for which this permit is issued, t shall not employ any person in such manner <br /> as to be me su it to Wo r an otion laws of California." <br /> Sign .---- ---- -C... ----------------- Owner <br /> BY ----- ----- Title - - <br /> - - ------ <br /> (If other than owner) <br /> FOR iDEPARTMENT' USE ONLY <br /> APPLICATION ACCEPTED BY .. _��-------------------------------------- DATE - <br /> BUILDING PERMIT ISSUED ==--- - -- -------------------------------------- ----------..-.---- ---- ------DATE ---------------- --------------------- <br /> ADDITIONAL COMMENTS : ------------•---•--•---• -- - ------­---------------------- --------------------------------- -- ------ ------------------------ ------ <br /> ------------I <br /> -----------------' =----------------------- - ---- - •--- --- - ---------------------- --------------••----------------------- ---------------------------- -----------..._. <br /> -------------------------- <br /> --------------•---------------- ------ ---- ---•-•---- -•- - - ---- ----- - -------------------- <br /> - ------------ ----- ----- -- ------------------------- --------------------------------/ ./ f -------•-- <br /> -- - - -- - --- -- - <br /> Final Inspects - -- •---- --------------------------------------------------Date . . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />