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' <br /> OFFICE USE: ` <br /> '"" APPLICATION EOR ����� <br /> �u��oo"°~xm�� <br /> - PonnhNu4��.����xz� <br /> 5�� 7 ^/' ''x--- ' (Complete in T�pU���0 <br /> , Date Issued «�� <br /> ��K Year From Date Issued <br /> Application | ho6efo e Son Joaquin Local Health District � o it to cnns�oinstallond install the work herein <br /> described. This application is n,"p"6e |ncompliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ~JOB ADDRESS/LOCATION .____,vf 7 <br /> Installation will serve: Residence Apartment House-F-1 Commercial �F)Trailer Court 0 <br /> W\om,| F]Other-------------------------------------------- Ae ^^ . <br /> Number of living un|ts`_/—. Number of bedrooms --A------ Grinder _A/pLot Size ' �'X—��.-... .0—.—. . <br /> Water Supply: Pu6||cSyv�,mon6non,e _ — Zia <br /> ^ g�`�.---'_-----.Private [] <br /> Character ufsoi| to o depth of 3 feet; SandE] 0K0 _ Clay ED Peat El Sandy Loom 0 C1myLonmlg <br /> . Ho,6po. FAdobe M, Fill Material ------------ |fyes, type -__'--'_'-- <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: (No septic tank or seepage pit permitted if public sewer isavailable within 2O0feot) <br />� <br /> PACKAGE TREATMENT [ ] SEPT|CTANK:11 <br /> S|ze.------�—_-----__-- Liquid Depth --.------. <br /> Copodty ----_..— Type -------------------- 8ote'| | '' . No' Compartments <br /> --------- <br /> Distance <br /> - <br /> ! <br /> x» .ne�nes� \NeU —.�--_--.--_---Foun6o��n---.--._-p,m�. Um* .----^'^--' <br />� iE/xCH|NG UNE No. of Lines --------- -------------- Length of each line—------------------------- Total Length -----------------_'-' <br /> 'D' Box ------------ Typo Filter Material --------------------Depth Rke, A8nhnho| -------------------- ----------------------- <br /> Distance to <br /> _--'—'--_0stonceto nearest-. Well ------------------------- Foundation ------------------------ Property Line ----.---'.... <br /> Rock Filled Yeo [] No �] <br /> . SEEPAGE P� [ } Depth -----.�— Diameter ----_.. Number ------'--- <br /> R�c���� <br /> Water Table Depth ----'_--_'_.—'-_'— -----'—'— <br /> ` '— <br />� <br /> Distance +oneomm` Well -----------------------------------------Foundation . . ProP. Una <br /> ---'-----' <br /> ' (Prev. Sanitation Permh# --------------------------------------------- Date _-_'—_.--'-_'—> . <br />� . <br />` i Septic Tank (Specify Requirements) -- <br /> ' Require <br /> .—. -°��Xwo�%�.--0[-��—����_ --.��.��..—.-- <br /> �i�' Disposal ld ' <br /> _--'—_'—__'—.--,-_--.--�-'-__'---_--'—.---- <br />� <br /> ,—_------'_'---_--_.--_--_----__-_---------_' <br /> , <br /> '—''--��------����----���--- |oh iro6o66hu�non �wv�owuk�e <br /> ' U]rovvox ng mJ ns1u side) <br /> � . <br /> I hereby certify that U have prepared thisapplication and that the work will be done in ac«wrUanie with Son Joaquin <br /> County Ordinances, State Laws, and Rules and R*gwla6mmw of the San Joaquin Local Health Dimmei^t' Home owner or limwm+ <br /> / ye6 agents signature certifies the following- <br /> "I werHfr that in the p�*mrmmucewf the work for which this permit is issued, | shall not employ any person in such manner � <br /> � <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed u�'no, <br /> . --- --- ''--'--------- ~ <br /> --_--�----'Th|o�—�� .___`_______.. <br /> owner) <br /> -' --_-- .�. _ ~- ' ' <br /> ~ rnon . <br /> USE ONLY ' <br /> BLY - <br /> uuuu/m� r�uxx// /��u�u . <br /> ADDITIONAL COMMf NTS <br /> ------. ~_ —�~�'—'—__---_-----'---'�__.—.—_--_._���� <br /> �'', <br /> —'—'---�'--'�----'-----'—'--�--- p�� --'— <br /> - --�--'--- --'—� _�o�� k��\= =.^ --.. � <br /> �n�| Inspection � ------'_-------_—__----------.--.. ' —_---. <br /> �--� ' SAN JOAQU|N LOCAL HEALTH DISTRICT � <br /> k, E.H. P l''68Rev5�A <br /> � ������ <br />