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------ Ar' <br /> - - -------------------_----- *;ATIONj;OR SANITATION PERMC) <br /> ----­-------------------•---..__.._ (Coniplete in Triplicate.) <br /> Permit Na <br /> ----------—----- ---- <br /> This Permit EXPh"s I Year From Data Issued P6te Issued <br /> 4)"Pliccition is hereby made to the <br /> �RWibed_ This application San Joaquin Local Health District for a permit to construct and install the work herein <br /> is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- <br /> 198 ADDRESSA lotions- <br /> 3wrier's Name <br /> ------ -------------CENSUS TRACT _-_S,17 <br /> Nddress ------ ---------------------- --------Phone <br /> .......... ----- ------- ------------------------------------ <br /> - ----------------- <br /> ',�Pntrcictoes NameCity <br /> ------ ......... • ------- --------------------_------------- <br /> f Wallati6n will serve: -- <br /> ---------- ---•---- -- ----- __.License <br /> w. -------------*------- <br /> Phone ------------------------------ <br /> Residence Apartment House f] Commercial oTraiW Court 0 <br /> Motel 0 Other <br /> _-_--- <br /> dumber of living units:-_/------ Number of bedrooms <br /> ---------------------------------- <br /> Nater Supply, Public -—-------Garbage Grinder --------- <br /> Systern and name __ Lot Size ----------­- -7 4r__..CW <br /> ------__---........ -----------I------ <br /> �aracter Of soil to a depth of 3 feet: San ----- -------- --------------—------------•------------------•---------------_. <br /> E] Silt 0 Clay 0 Peat El Sandy Loam 0 Clay Loarn <br /> Hardpan'E] Adobe 0 ❑Fill h(aterial ------------ If yes,type ------- <br /> Plot Plan, showing -------- ............ <br /> size Of lot, location of system in relation to wells, buildings, efc. must be Placed an reverse <br /> verse side.) <br /> 4EW INSTALLATION; Wo septic tank or see pa <br /> ge Pit Permitted if public sewer'Is available within 200 feet.) <br /> �AC-.KAGE TREATMENT SEPTIC TANKW- Size 5� <br /> Capacity Mpiq-44 ------ ----- Liquid .Depth ___C/-•----------- <br /> dterl- Type <br /> Distance to neareft. Well -------- N& Compartments <br /> (ACHING LINE -------- ------------Foundation _e, -A-----=---- 0 <br /> No. of Lines --------- - of Prop. Line J'./_,,_,....... C <br /> `D' Box ____ 3---------- Length ach fine-------- ........... Total Length .------ <br /> I—— Type Filter Material ------43__1Z__Depth Filter Material 40'r ' _--- <br /> Distance to nearest. Well ---. ? e ............ -------7----------- - <br /> ELPAGI PIT ----- Foundation -------- ---- Property Line .- -_p - <br /> Depth ---t;� <br /> '3 Yes <br /> Diameter Number ------- !_ <br /> Water Table Depth ......... —----------------- Rock Filled No Cj- <br /> -Rock Size <br /> Distance to nearest. Well ---------- __t-------------Foundation ...... Prop._ <br /> Line ------- <br /> !PAIR/AUDM (Prev. Sanitation Permit# <br /> Date ----- <br /> ................................... ......................... <br /> Septic Tank {Specify Requirements) ------------ ------------------ <br /> .'�Dlsposal Field (Specify Requirements) ------ <br /> 7--------------------------------------- ------------------------------------------ ---------------------------------- --------------------------- <br /> ----------------------------- ---------------------------------- --------------------- ----------- <br /> ------------1------------------------ ---------- ------------------•--------•-•------ <br /> -----------------­_­------------- -------------- --------- ------------------------- <br /> --• <br /> ----------- <br /> --- -------- <br /> (Draw existing and required addition on'_reverse___side)_ -.------- .............__----------I------------ <br /> hereby certify that I have Prepared this application and that the work will be done-in a <br /> Jccordance with San Joaquin <br />;DuntY Ordinances, State Laws. and Rules and Regulations of the San Joaquin <br /> ed:cgents signature certifies the following- Local Health District. Home owner or licen- <br /> ucertify that in the petformanci, of the work for which this permit is issued, I shall not employ <br /> become subject to Wo compensa laws of California." any personin such manner <br /> fined <br /> ---------- Owner <br />---------------------- <br /> A <br /> tll­�wnerjl <br /> (if other nerl <br /> xitle _ 1. <br /> R DEP <br /> E E FOR�-DE TMENT USE ONLY <br /> PPLICATION ACCEPTED By . <br /> G PERMIT)ILDING PERMIT ISSUED -----------------•_----_--777777777;DA;TZE <br /> M ---------------_------------­--- <br /> ONAL COMMENTS ------------------- ------------------------------------- --------- --------- -------------DATE <br /> ------------------------------------ --------­----------- ---------------------------- ------"I--------- <br /> ------------------------------------------------- -------- --------------I----------1--­--------- ----------I-----------­------------ <br /> I-----------------I--------- --------- <br />... -"--__-,-, -"----------- - ------------------------------- <br /> ------------------------I----------------------­---- <br /> -­--------------------------------------------------------------------------I------------------------- <br /> nspetn ­ ------------- <br /> ---- <br /> ----------------- ------ --- --------Date <br /> ---•------------------- <br /> SAN J <br /> OAQUIN LOCAL HEALTH DISTRICT ------- <br /> 1. 9 1-'68 Rev. 5M 10 <br />