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W4 OFFICE USE: <br /> c AFPLgCAY!OrJ FOR SANITATION r AIT <br /> ---7;.3-o.....z,:N%0V Permit No. <br /> (Complete in Triplicate) <br /> ........ ........... .......... <br /> ............................................ .... This Parmit Expires I Year Frrm Dot*l5sued Date Issued <br /> A <br /> work herein <br /> Application iz hereby mccle to the Son Joaqvin Local Health District ror a permit to constru-t and Install the <br /> described.This a plication is made in cc <br /> F, P mplionce with County dinonce 14o. 549 amiexisting Rules and Regulationst <br /> q .. ...t-,V. 7d� CENSUS TRACT ........................ <br /> if j JOB ADDRESS/LOCATIC.1 <br /> ...................... <br /> Owners Name ..... .......................................................Phone ........... <br /> iV1., Address ........ . ............................................................ CityAwlvelew---7:m—..................... <br /> -,i <br /> �.ZT` Contractor's Name......... <br /> -51�Cet&o.7r,:....................... LIcenso Phon <br /> Installation will zerve� Res;dence <br /> %Apartment House 0 Commercial oTrailer Court 0 <br /> tr Motel[]Other............... ......... ................ <br /> '97 <br /> Number of living units:../.... Number of bedrooms .—I.....Garbage Grinder &P.. lot Sil-RA2 X-1-a. .........I <br /> Water Supply: Public System and name ......................... ...........................................-------------------------------Privatex P <br /> Character of ioil to a depth of 3 feet: Sond)�' Silt 0 Clay C] Pact C) Sandy Loorn 0 Cf�y L*3m <br /> Pardpon Ej Adobe [] Fill M�terial ............If yes,type.......................... <br /> (Plot plan, showing sizb of lot, location of system in relation to wells, buildhigs, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit parmitiled IT public seer is available within 200 feetj <br /> PACKAGE TREATMENT SEPTIC TANK f Size.............................................. Liquid Depth ............... <br /> Capacity ......... ....... Type .................... Material...................... No. Compartments ....... <br /> Distance to nectrest: Well ................... -oundation...................— Prop.Line......... <br /> .................. ........ <br /> LEACHING LINE No. of Lines ........................ Length of each line--- ....................... Total Length .....:�.................... <br /> *D' Box �........... Type Filter Material ...................Depth Filter Material ....................................... <br /> oistance To nearest: Well ....................... Foundation ......................... Property Une ...............------------ <br /> Cj No C3�� <br /> SEEPAGE PjT Depth ---............ Diameter ................ Numbor ............................ Rock Filled Yes <br /> WaterTable Depth ................................................Rock Size. .............................. <br /> Distaricn,1,� nearest: Well ........................................Foundation ..... ............ Prop. Line ................... <br /> REPAAR/ADOMON(Prev. Sanitation Permit#.......................................... Date .................................I <br /> -—---------------- <br /> Septic Tank (Specify Piquirriments) ............ ----------- 14...............X..............................7... <br /> r Disposal Feld [Specif� Requirements) --------- .......... <br /> .......... <br /> ................................................................................ <br /> ...... ................................................................................. ........................................................................................... .............. <br /> Dro�',exitit;ng and required addition on reverse side) <br /> I hereby certify that I have prepared ibis application and that the work will be done In accordance with Son Joaqvin <br /> County Ordlnonco�, Stcte Laws, anE! Rules and Requisions of the San Joaquin Local Ifealth District.Home owner or llce� <br /> 31 %ed ci�jnls signature ceitiPes the following: <br /> "I certify that in the pwfarmance of the wo?h for which this permit is issued, i shall not employ any person In such mannor <br /> as to become sublect to Workman's Co iperisation laws of California." <br /> Signed ............. Owner <br /> ................. Xitle... <br /> 3Y........ <br /> ----------------- <br /> ioh,71" ',Wdwme, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED b�<,�"MC5....Di\----ks�� . .. ..... .................................. DATE..... <br /> T V <br /> SUILDING PERMI SSUE& --------- ........................................................-....................DATE....................... <br /> ............................. ....................................................................... <br /> ADDITIC 44AL COMMENTS....... ...... ................................ <br /> ............... ....................................*......** . ........**"*....... .......—.................. <br /> .......................... ....... .—...........I..............I--.......I......................--.....................................................................I., <br /> ................. ...... — - ..4:� <br /> . IT <br /> —w -y ....... .......... .... ................................ <br /> �inol Inspection i4:c........I....... ..................................................Date ........ <br /> SAN JOAQUIN LOC!kL 'HEALTH DISTRICT <br /> iy:- <br /> E.H. 9 1-'68 Rev.SM <br /> .'-dY <br />