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kN <br /> FOR OFFICE USE: <br /> . <br /> ' FOR OFFICE USE <br /> P <br /> ; <br /> �1 <br /> (Complete in Triplicate) '4 <br /> Permit No...7_2'_ <br /> ,i Date Issued_.__..____.__.___._ <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 described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _ --------------------------------- / KK - -- -�-CENSUS TRACT------------ <br /> f . <br /> ner's Name - <br /> -- Phone.-. ��8�� <br /> AddressA;�9472Y----- -' ---- ----------- ---- --------Cit .J-- --- ----- <br /> ----------------- <br /> [ <br /> . _ P <br /> Contractor's Name___ ____ . ._ License #- � _-__.Phone._YGS_a6/+% <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial �0' Trailer Court ❑ <br /> ` units:._'_._______. __Number of bedrooms_. Gar.ba a Grinder-----_- u L I * _ _ <br /> Motel <br /> Number of liying ❑ Otho ex.-�------------------------ --- = -- - ---- - - - �-------------�---------------------- <br /> Water Supply: Public System and'name------------------ --- --------- -- --------------------------------------------------------------- -------------------------------- rivate' <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ . Peat ❑ Sandy Loam ❑ ;Clay Loam [ <br /> Hardpan ❑ Adobe❑ Fill Mate' ria.l-------------If yes, type_______________________________ <br /> iPlot 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 seepage-pit permitted if�ublic sewer is available within 200 feet,) <br /> �3/1 -: , � <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size__ l__ -------------------------------------------------- <br /> ---------_X "_-_______'_____._=_:______._Liquid Depth..___`__ _____________ <br /> Capacity L}v-_-.�:Type -`' 7 �r P off' <br /> Material-C�C�----- No. Com attmeets------------------------------ �' <br /> Distance to nearest. Well.../a1�4_ ...,-_ _-,.•:-_Foundation -----.----Prop. Line-6 _ /_`____.. <br /> LEACHING LINE. No. of Lines _ �y + f S d Length..-- -, U- ------ ------------- <br /> .__ -r_.Length of each ImBe - _ QQ _ Total <br /> ' 'D' Box- --- ---Type Filter Matenal__-� _1�_ Depth Filter Material__-_! <br /> --------- ---------- <br /> ,. Ql.�_ Foundation.--.'-6- = Property Line 4-... <br /> Distance#nearest: Well. --„ ,_• ;_ . .. -SEEPAGE PIT [� p h-_ ____; --Diameter"------------- ----Number--- .----�------------------ RockFill .Yes�»s61 <br /> Water Table Depth ----r -- - -- ----------------- ----- hock Size----Distance to nearest: Well /o_dQ.�____________________Foundation._ Q___._________-Prop. Line____ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--°____-- '-------=----- --------------- ------Date-------------------___.---------_------------_} <br /> Septic Tank (Specify Requirements)----------- -------------- --- -----------------------------------------::__---------:------=---------------- -- ------------------------------- <br /> t <br /> Disposal Field.(Specify Requirements)-------=-------------- ---------- ---------------------=------- ------------------------ <br /> ------------------------------ <br /> I <br /> ..., <br /> - - -yam:.:- ... .. <br /> f- <br /> ------------- ------------------------------ ---------- -------------------- - ------------------------ ------------- --- ----------''--------------- <br /> (Draw existin and required addition on reverse side[ <br /> 1 hereby certify that I 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 Son Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: f , <br /> "I certify that in the performance of the work far:which this permit is issued, 1 shall not employ any person in such manner+as <br /> to beta bi ct to rkma 's "Com,pensation laws of California." <br /> � t <br /> Signed----- --- -------- -- -------- - ;- . <br /> Owner <br /> BY-------- ----- -•-------• ----:Title--- - ! ---------------------------------------------------- <br /> .. <br /> ---- ------ w <br /> (If other an .owner] s i <br /> i <br /> 00 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__ { <br /> = --- ----- DATE. f� <br /> DIVISION OF LAND NUMBER----- -------------_ <br /> ----- --=--------------------------------------------------- -----.DATE------------------------------------------------- <br /> ADDITIONAL COMMENTS_------- <br /> ---------------------- ---ADDITIONALCOMMENTS-------- >------------------------------------------------Z------------------------------------------------------7---------------------------- -{-- <br /> s � :h : <br />