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A. <br /> APPLICATION FOIL SA <br /> FOR OFFICE USE: N17ATIOAI PERMIT <br /> �— Permit No: .. .._._.. <br /> .......................:...... (Complete_ ntTriplicam_ tel <br /> :...............................................••-- <br /> Date issued �r�._ . ...... <br /> � <br /> This permit Expires 1 Year From Data Issued <br /> Application is hereby made to the San 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. 9 and existing Rules and Regulations: Y <br /> JOB ADDRESS/LOCATIO �" -.7� ._ .; ........ •.- .._ <br /> .:�..... CENSUS TRACT - . <br /> ..Phone.` 7..7.. 1.. . . ... <br /> Owner's Nome ......'d .. ... . ... . .� R . ....... <br /> aa City ...... . ...... <br /> Address � a_- � �/�.. 7-� ; <br /> .._.•... `�` <br /> �_ one <br /> F <br /> E Contractor's Name 1 .................License # �. � Ph <br /> . r_..... ❑ ❑ N} <br /> Installation will serve: Resident Apartment House Commercial Traiter Co 0 I <br /> T Motel []Other <br /> .1/z.2� _.:. _ <br /> Number of living units.:__........ <br /> Number of 'bedrooms ............Garbage Grinder Lot Size ..............................:............. <br /> Water Supply: Public Sy tem an name --------- ------------------------------------------- <br /> -----------•--- Private Q <br /> Character of soil to a depth of 3 feet: . 5and j] Silt 0 Clay [l � Peat❑ Sand Loam Cj Clay loam Q <br /> % R I <br /> Hardpan ❑ Adobe F ll Material ....--...... if yes,type ........ ................... <br /> {Piot plan, showing siie of lot� location'iri'f ystem in relation to wellsAuildings; etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No s4tic tank or seepage pit perrniitttted,,�i�f public sewer is available withirf 240 feet,) <br /> 4°ACKAGE TREATMENT [ , SEPTIC TANK.{_j Size`s ._ --_---• liquid Depth ..---•.....................II <:-„ , No. Compartments ...................... <br /> I Capacity...t .:... Material.. <br /> TYPe -••---•-•-•-•------- p <br /> Distance to nedres? Weil scion Pro <br /> e ..•--... . <br /> of ach line._ { <br /> � � � - ..............Fou <br /> LEACHING LINE `{ No. of*Lines •---- - Length �?----•;. ---... Total Length?.. S•••=-•- <br /> A #° ..._....+... <br /> De pth filter Material ./.•-sY... •--•- <br /> T e Filter Material . _. p "'” <br /> D' f3ox-' -•-••• r . I � <br /> Foundation p rty .._..._..... <br /> r <br /> °•� l7istante 'to nearest: Well ............... <br /> `r ? Pra a Line <br /> i <br /> i ' ock Filled Yes <br /> } SEEPAGE PIT Depth . : .. Diameter--•.--. Number �•----------------• ,Fi o Q <br /> I - R N <br /> r `._ ; .... f <br /> W:ate Tale De th <br /> ......[Rack Size 1 t5-.'.Z� _. <br /> p •----•-... •..... ............ <br /> _ -- foundation g ...... Prop. Line <br /> Distance t nearest: Well -a-- .... ._... ...... . <br /> $ �'` ate <br /> REPAIR/ADDITION(Prev. Sanitation Pe(mit;# ...:............ -----•-•--•------• - ...._� <br /> Septic Tank ISpecify,Requirements} � `� `:' <br /> .....................................-..-.....___......... <br /> N � .: <br /> Disposal Field 1Specify Reeuirer"'nts} . ----•.-3�=•-.....---- <br /> i <br /> rwf f <br /> ............................... <br /> ............... ...... <br /> Draw existing andtre4eiited'additivn on reverse side} <br /> I hereby certify that I have prepared this application and th�atfthe work will be don* in accordance with San Joaquin <br /> County Ordinances, state Laws, and Rules and Regulations of;te son ac <br /> Local Health Distrkt. Homs owner or licen- <br /> sed agents signature certifies the following: � p <br /> -in-ythe,performance of the w-ark.for which Perpersonis issued, I shall not employ aeSY PRrson in such manner <br /> I certify that p �^ <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed y: :. ..::. .............�.._._:\JQ.hOwner , <br /> By .. <br /> ��./t l ` ......._ _. <br /> itis f - <br /> (if other t n owner) <br /> F0JJ DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 6Y _.. <br /> ........ DATE. <br /> ...��.. i <br /> DATE <br /> BUILDING PERMIT ISSUED ... ... <br /> ADDITIONA OMMENTS .. l,�C �L_ @lt/@[!. �1r-�G....�rf�i -. - w•---.�.��. <br /> �fR L ��!tl d• r e l_ Jit"Aiyo. .............................:............. ••-••••------••••-------•.......----•......_..---" ......................----...... <br /> } -•..___• ....__---•- .... _•. r� '' -_. ....... ......... ..Date f .. -=..-. <br /> :.:........ :.. <br /> . r - J! <br /> ,�y� <br /> Final inspection by: ....1��..(l. .. ... ._'.. ... -•- - . <br /> SAN JOAQUIN .-LOCAL HEALTH DISTRICT <br />