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FOR OFFICE USE: <br /> " "' 'ION PERMIT <br /> ------- ---------------------------•-------_----�-'--- APPLICATION FOR SANfTAT . No. -- ------------____-- <br /> t (Complete in Triplicate) Permit <br /> = ------------V-- ------ <br /> j� ,. �,, f i - �• Date Issued <br /> AA � ��� �___-.--_ This Permit Expires 1 fear From Dale Issued <br /> Application'is hereby made to the San Joaquinn�oeal-flealth Distict�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 [Zules and Regulations: <br /> � r� �-- <br /> ----J,OB ADDRESS/LOCATION -Va6z d49g_- - r -� TRACT ') <br /> INC <br /> Owner's Na}}me --- G�. ------W��_ _per ---fir`-'- _ r- Phone <br /> Address -----k � �t.� d - ij'.c' City L ? <br /> Contractor's Name _____ - _ __.License"#% �� hone <br /> .-t Ir. r fir° ------------------- "" _ <br /> Installation will serve: Residence [Apartment pause,[D.Commercial�M.Trailer Court ',❑ <br /> Motel ❑ Other ----------- ------------- <br /> Number of living units:_-_ Number of bedrooms .. Garbage Grinder L Lot Size ��_rr --- <br /> Water Supply: Public System and name -------------�------------------------------------------------------------- Private <br /> ----------------------------------- <br /> Character of soil to a depth of 3 feet: Sand'[] Silt❑, Clay ❑ Peat❑ Sandy Loam Clay Loam;❑ <br /> j. Hardpan,❑. Adobe ❑' Fill Material -f __- If yes, type ---------------------------- <br /> _ y � y _�. . _ s <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings etc must be placed on reverse side.) <br /> NEW INSTALLATION: 4 (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) " <br /> PACKAGE TREATMENT { ] SEPTIC TANK' Size-_"j01,0k-91hej`-i------------------- Liquid Depth — ---------------- <br /> Co <br /> --_------- <br /> I1 Copacity12-00--.,-- Type � Material_40-oIdB---- No. Compartments __ .--__--_ <br /> 1� Distance to nearest: Well _---Foundation ----------- Prop. Line _ <br /> �4 LEACHING LINE [ No, of Lines --------__ Length of each <br /> line _ae9 ---------- Total Length _,:PO-•f------------ JQ�P4F" i <br /> 'D' Box/ Type Filter Materl4l,;&6/6Depth <br /> ' <br /> Filter MaterialF`..-_--------------- -------------- <br /> It' <br /> r <br /> Distance to nearest: Well --------- Foundation ----------- Property Line <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Num'ber ---_ --- ------------- -Rock Filled -Yes ❑`""No .[] <br /> his Water Table Depth -------------------------------------------------Rock Size ----------- -------------------- <br /> Distance,to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------.------ ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------- ------------------------------------ Date ----------------------------._.__-1 <br /> SepticTank (Specify Requirements) ---- -------------- --------------------------------------------------------------•----------.---------------------------------------------- <br /> Disposal Field (Specify Requirements) ------------ ---------------------------------------------- ---------------------------------- <br /> -------------------------- <br /> --------- -------------------------------- --- --------- - ------L---- - ---------------------------------•----------r--------------------------------------------------------------------------------------------------- <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 Joat�uln-'_-- <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 /> "Ccertify that in the performance of the worts for which this permit is issued, I shall not employ any person in such manner i <br /> as to become subject to Workman's Co nsation laws of California." <br /> Signed I ` Owner <br /> ----- ---------------------- <br /> t -':- --- j <br /> BY Title > <br /> --- - -------------------------------------- <br /> t (If r t an owner) <br /> g td ' <br /> •* I/ . 6 FOR .DEPARTMEN US ONLY <br /> APPLICATION ACCEPTED BY _-'""__Z _----_7----� <br /> ------------ ------------------ DATE ___z_~-Z-----_-7 a <br /> BUILDING PERMIT ISSUED --------------------------------------------------------------------------- <br /> --------------------DATE ------------------------------ <br /> ------------- <br /> ADDITIONAL COMMENTS -------------- ------------------------------ ------------------ <br /> i <br /> ---------------------------------------------------------------------------------------------------- <br /> ---------- ------------------------------ ------- --------------------------------------------------------------------- ----------------------------------------------------------- <br /> �! - --------- `- --------------- ----------- ----- --- ----------------------------------------------------------- <br /> ----- --- - - - - <br /> ;t Final Inspection by: r <br /> -----------------.Date - - ; <br /> ' ! SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M t� . <br />