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FOR OFFICE USE: <br /> a <br /> 4 APPLICATION <br /> . <br /> t FOR AI`j„,iON }PERM _ 7 ..•.......................................... Permit N0 . --...... <br /> (Completelln Trlplicatel <br /> ............................................... <br />........................................... <br /> Dme1s#iil Date Issued . _..: :7 <br /> This Permit Expires 1 Year From � <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct:a4hd install the work herein <br /> described. This application is made'in compliance with County Ordinance No. 549 and4'{existing Rules and Reguiotions: <br /> J08 ADDRESS/LOCATION <br /> N ./�/ ------ •- .-- ...�r C •........-L4 ._, ,1...CENSUS TRACT . ._.-” .....- <br /> e ---------- ------Phone <br /> Owner's Name ..--- - �-• - ------. .����_,r._... --....... � -- - �� ��---- --'� <br /> Address -- w t° t .._....,. ,f'rr .t 1!. 'l Y�/.. ---------------------• ......City .. � .._.. ......_.......... ' ;'- - <br /> Contractor's Name le __._.License# ......................... Phone "-------- <br /> Installation will server Residence Id Apartment Houseo Commercial frailer Court r <br /> ft. e-v�,, / S�� .. <br /> Motel ❑Other...... ....:............................:: <br /> Numi1,1 er of living units:.-f--A_ Number of bedrooms ------___---Garbage Grinder��!._..__ Lot Size ___----------------------------------------- <br /> Water <br /> -•----- -.----Water Supply: Public System and name ................................................................_-_�.................. .Private Q <br /> Character of soil to a depth of 3 feotk Sand 0 Silt Q Clay 0 Peot,d Sandy Loam ❑ Clay Loam Q <br /> . Hardpan 0 Adobe 0 Fill Mctterlai ............If yes,type .............. ............ <br /> (Plot plan, showing size of 40,, ovation of system In relation to wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: (No septic.tank or-seepage-pit per mittedV-jwblic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC-TANK f 1,9; I )rV4� <br /> ize....���G'-...............--t._.:.--- Ligiuld Depth .................... <br /> Capacity �, .... Typ aterlal. No.`-CQmpar'tt,nents _. ..�-......`O <br /> .Foundation ----- - <br /> -24 <br /> Y` Distance to nearest: Well .....��..............:.....: .._��'_ :-. :�...fProp. Line __,�:t'..: <br /> r .. <br /> LEACHING LINE No. of Lines ___ _________ __ _ ____ Len th of each Ii e--- --. - ___- Notal Len the <br /> _. <br /> . T Filter MaterialJ1__2.. epth Filter Materiel�...4`-,_ --•--- •-----•- ti �} <br /> D' Box ._... Type �.�,*...... <br /> S' 47P Q f Distance to nearest: Well ------� .0...... Foundation ---,/0...1---:_--- Property"Llne ---..�.�-._...---• <br /> ( ] Depth ----10 ,Dim —YX--?-----cNumber :....__sem_..---I.___-'- Rock Fii�d:�Yes No Q <br /> 4r 1 <br /> Water Table Depth ............XV.......... -•- .....Rock Size f 2-« <br /> M <br /> - f <br /> Distance to nearest: Well ._..:�? _`"�:•_:...��'.___._.'Foundation .-,/: ......... Prop. Lin® <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ~� " Date .-- •-----:-•-£--.. <br /> ...................................... <br /> ...---.._ .............. _....---- <br /> Septic Tank (Specify Requirements) --- ---•- -•------•-----••-•-- .............f.... .................. ..---.:.. ---_-c--.__.......... ---------- <br /> Disposal Field (Specify Requirements} <br /> s <br /> - ---•----- - -- <br /> _(Draw existing and required'addition on reverse side) <br /> 1 hereby certify that 1 have preparedthis,application and-that the_work will be.done In accordance with San Joaquin � <br /> County Ordinances, State Laws;_ond Rules and Regulations of the`$od Joaquin Local Health District. Homs owner or licen- <br /> sed agents signature certifies the following <br /> "I certify that in the performance of the work for which-this_perm[t is_Issued,..l-shalt-not employ any person In such manner <br /> as to becomIF,070' / <br /> t to Workman's Cam en ton laws of California." <br /> Signed A----- - ------ �! p ---------- Owner <br /> BY ----- •-- '*-._:..__. Titley'-.-. f `` ---------------------------------' .................---------------------- <br /> .. <br /> (If other than owner) � 4,� <br /> FOR46EOXRT14ENT USE ONLY <br /> APPLICATION ACCEPTED BY.--.- -.----•--•-----• DATE .. -� 1. _.�f............ <br /> BUILDING PERMIT ISSUED _.. = ` - _.-:......`�...:_..... DATE .......:.:...... <br /> -- <br /> ADQITIONAL COMMENTS `r :`.'.`-.........._. ............ ................ <br /> ------------ ...................... •-• <br /> ----------------------- ---•---•-•-----•-------------- ..............................................., •---•---.._---_...----- ......-.,-•------------------------------. ------ <br /> 3 � <br /> _.. --•....... .. ........... = --/l_._, --- -______----•-------.._--,._---------------- ---------------------------- <br /> .------------------------ <br /> --------------- <br /> ... - -__._-_-__----. <br /> Final Inspection b SAN OAQ -•---- Date - :_ -- .............. <br /> EB 13 22� 1-6f} Rev. iLQCAI. HEALTH DISTRICT 8/711 3M <br /> 1(J"� R _ <br />