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FOR OFFICE USE: <br /> -•---..._.-:�a:36.._..---`-- RMiT <br /> �f <br /> Pl, CATIOPI FOR SANITATION <br /> F (Complete In Triplicate) Permit.No. a�"�-.��_. <br /> - - -7f, <br /> �-�7 Data issued'-. .. -_.._____. <br /> ...........:...:.......7._ !_._._ .. ........ This Permit Expires 1 Year From Date Issued <br /> Application is hereby mace to'the`Safn 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/LOCATION ..CENSUS TRACT ...",I�"................... <br /> •-�, <br /> Owner's Name �..:---............ ............. one ..._--......------ <br /> Al, .".."-".. .... ......_RPh <br /> Address ..-._..._, .G --SV . . _-._. cis f ec�.rS�2�._ -. City . ". <,-� <� ...C�- 1! <br /> .: <br /> ^ _ on <br /> Contractor's Name L" s. C .._ irk, r__yrs! � ± ..License-,9E .. 5`j f .5iZ <br /> Installation will serve: Residence Q Apartment House flMCpmmercial railer C__— <br /> • I <br /> Motel ❑Other...... -e.4e -f f,./4 7 7': <br /> Number of living units---_------- Number of bed% oms ------------Garbage Grinder Lot Size : t,/� <br /> Water Supply! Public System and name ----------- <br /> -•-_ --•--�,L.}t c- } .. i' <br /> Character of soil to a depth•of 3 feet:�- .Sand,E] SiltEl Gaye Peat❑ Sandy loam 0 Clay Loam [] <br /> + II <br /> ,Hardpan E] Adobe Fill Material <br /> ] ............If yes,type............... .......... <br /> (Plot plan,,ehowing size of lot, location of system in relation eto wells, buildings, etc. must be placed on reverse side.)Q <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted"if public sewer Is available within 200 feet,) <br /> PACKAGE ThATMENT.—{rl,_.,..SEP.TI.CJANKf._} d�5ize._........�?'�`X... Liquid Depth ...-� .............. <br /> Capacity � ? T e ` <br /> S <br /> -.p tY -- - - - - Yp •--�t--`�'•�"Material--- -�x.. IVo., Compartments ...._._._ <br /> Distance T6 nearest. Well _.___ � -. ...Foundation :?t... Prop. Line .1-4. .... <br /> LEACHINGLINE [ ] No. fof Lines` !! line.± ._ Length of each ----- .0............. Total Length . ..1 .............. <br /> D Box . •�.,. T e Filter Material .- :RC1 -Depth Filter Material ._...... .. ........................ <br /> f .t Distance to nearest- Well _.�.r�x Fourldat�on .__.fL7...._:.__.-_- Property �e ....� <br /> . .f r. 1----------------- Rock Filled Yeses "• <br /> SEEPAGE PIT: ' M�' � <br /> { ] Depth. .:��..._ . Diameter ,��.... Number -__-•-- l�Fra � <br /> Water Table Depth €�� .-•- '---- -�----�---••--- � f— <br /> a � _.. p -•---.. .. ...-•r -- - - Rock Size .-- <br /> F t p. ` <br /> Distance to nearest. Well !sem:-....__. Foundation ._.jC�..._.._... Pro Llna .LIS............... <br /> REPAIR/ADDITION(Prey_Sanitation.Pe.rmit#-------------------------...............------.Date ......__..___...._. _....----....-) �I <br /> Septic Tank (Specify Requirements). - ..---"-""... ...........-•"------...._.._........_...-...__..................---• 4 <br /> Disposal Field [Specify Requirements] --------"- ----------------------------------------------------------........................................................... <br /> .._.. <br /> a <br /> ----------­------------------------------------------ ---------•----------------------------------------•---•---•------•--••--•---------------------------------•------•------- --•-•-•-------•-- <br /> - II � <br /> -------•--------------- - ----- <br /> )Draw existing and required addition on reverse side) I� <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 Real&District. Harte owner or licen- <br /> sed agents signature certifies the following: u <br /> "I certify that in the performance of the work for'which this permit Is issued, I shall not employ any person in such manner <br /> as to becam to Workman's ompe sation laws of California." Ip <br /> Signed ---- I -------- .---•�`"�- Owner I� <br /> ------------------------------- Title _... F <br /> By _ ---------- ------- <br /> lIf other than caner 11 <br /> FO IEPA tMENt USE ONLY M <br /> APPLICATION ACCEPTED BY -._....._ _ -------------- DATE,.._._.., . .. - -...:------ ------- <br /> -----------------------------•- <br /> BUILDING PERMIT ISSUED -- ---------------- ------------------------------------------------------DATE ------ --•--•-•- •- ----- --- <br /> ADDITIONAL COMMENT X ......... ............•... ; <br /> ---------------- ------ --- ----------------••--•- ...............................•......•............ ....., ------- .._..-............. <br /> -. .._..-•--•-----..-- _. .�- . ..__... <br /> -------------- . .... <br /> Final <br /> EH 13 Inspection -•lieu, � SAN JOAQUIN LOCAL HEALTH DISTRICT Date ........... . .... ......I;.--.--•.-.......__ <br /> 8/7!t i1 3M <br /> I : <br />