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FOR OFFICE USE= gppMCAT#ON OR SANITATION_?Wff ,,., � : Parrr+te No. : ..�a.:7. ' <br /> ..::......::.:.:.............:.:.:..... ICornpiete in Triplicate) <br /> Date issued <br /> i <br />........... ............................ ........... This Permit Expires 1 Year From Date Issued <br />,.�......................... <br /> Application is hereby made to the San Joaquin tow � Cou District <br /> t0 Ordinance No. 549 and existing Rules t and Regulotlonss <br /> Health and I <br /> PP licotion Is made In compliance I <br /> described. This app ......CENSUS TRACT ................. <br /> ADDRESS/LOCATION ... .. ._ /.• ... /.!.. ho .... <br /> . ......... <br /> 9 �.:.Y/, ..... <br /> ,108 ...... .. ..... <br /> Owner's Name) <br /> Address ' ... ....... ... <br /> City - .. <br /> ........ 2;�:.? ....., •�•- • ••-•• ... � l phone 02:� <br />'I . Aicense .. .. ...tf. .. <br /> Contractor's Name . ................ <br /> Residence XAportntent House Commercial QTraller Covet ] <br /> 4 <br /> Installation Will serve= I ...........................................• ........ <br /> 1 . Mata)Q Other <br /> - � - --Garbe s I der ..• V= Lot Size .. ..... •.............. -� <br /> Number of Giving units. �. Number of °mr__, __• _... ,.� .G..�.- --•-• . ............•---•-•........ •,•„Privets�'� <br /> I Public system and name . , ..aE!. —� <br /> Water Supply= Y Peat Sandy Loom Q Cloy Loam t] <br /> I Character of soil to a depth of 9:feet: Sand❑ Silt D Clay 0 <br /> _if as , <br /> Adobe Fill Material ...... yes,hype• ............ ....... <br /> "Hardpan Q .. . <br /> 1 <br /> Plot len, showing sire of lot, location of stistem in relation to wells, buildings, etc. must be placed on reverse side,) <br /> ( P d if public sewer is available within 200 feet,) <br /> No ae is tank or seepage it permitted p <br /> _NEW 1NSTALLATIONi ( Pt • � Liquid Depth <br /> f PACKAGE TREATMENT ( ] SEPTIC TANK( j j��'4 ��ie'. Materia” ...................... <br /> �.. . No. Compartments .......•.......•... <br /> ! Capacity ............... .... Type .................... -• Prop. Lina......... .. ...... <br /> ' oto Weil ....Fou dation . <br /> Distance nearest= ......................•-....... ........... <br /> LEACHING LINE No. of Lines ...... <br /> .......... .i.Length of a line � .... Total lengthl�� <br /> ''D''8ox -a •,..TYPe .Depth Filter Material . . ................... <br /> .......'.,.. <br /> Filter'Material - - �• <br /> We11= Foundation .:., Properly-Line . <br /> Distance:to nearest= . = <br /> ' " / il.?,�.�.... Number . Rock Filled Yes ( No C3 <br /> Diameter _.....---...�.......A � <br /> SEEPAGE PITS Depth f .••-...... 0 7 •.......... ............ <br /> Water Table Depth ...- ..................Rxk Siref• _ ��' ./... <br /> ... <br /> i .......... Prop. line - <br /> Well ...................Foundation <br /> I � Distance to nearest: -. • ...._. <br /> REPAIR/ADDITION(Pray. Sanitation Permit# .................... ...... ...... ata ...................................� .... <br /> .............. <br /> Se tic Tank (Specify Requirements) ............... .. `....... .. �-�. ............. c ............. <br /> DisposalµFieidR(Specliy Requirements) y ...................................... <br /> __ _ .............. �� .. ... ..............................._ ............ <br /> ...__.... !.......«_ }; )Draw existing and required addition on reverse side)- ......... .,.•..•_._...••.__„•,...._.. Joaquin <br /> Is I - , w� - t lion and that the work will be clone in accordance with Sonq <br /> I hereby certify that.! have prepared this.appllca <br /> i Cheney tensa th , State Laws'. and mules and Regulations of the San Joaquin Local Health Dtstrlct. Home ovvrter or lican� <br /> sed agents signature certifies tho following:' <br /> ,I certify that-in.the performance of the work for which this permit is issued, I shall riot employ any person In such manner <br /> as to become-subject to Workman's Comp nsation laws of California.” Ct,AR.ENCE'S SEPTIC & SEWER .SOVIC8 <br /> F 3 .......................... Owner <br /> } Signed `x , ...... ....... ::•.... 2� 50: Ara �a 51o�#;ton, Calif: 95205 <br /> y"7: ---•-------------- title .......P!1, C,3-;2��E}q....�6�i1'ifi.wo zic.�1v 77, <br /> ley :......... _(If other than owner) <br /> ' <br /> FOR DEPARTMENT USE ONLY <br /> � ,�. . DATE ..... _7 ... <br /> d .._ ,� - - -. .._........ <br /> APPLICATION_ACCEPTED $Y -- �. <br /> - '_ ";.... ATE :. . _. .� <br /> BUILDING PERMIT ISSUED ......... f �C ',b_e or � <br /> C D <br /> ,..-rADDIVIONAL CO <br /> N S�:..` �. .... h`..._ . <br /> ( .. ... ..t-. _ ... f <br /> •1 <br /> ._- E <br /> ............. o.5.....k� .. <br /> �....� �• a+��f..ylPar.�i. <br /> �?�..... .... . ............................ .......... ....-.......'Date <br /> ... .g ..�� 7 <br /> W .. . <br /> :iinc&lns ection by , ,. ..- . <br /> F �YEI%13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT <br />