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rVX VrrKA u5b <br /> AiwcArom mit SAmArom PERMIT 77­2 7� <br /> ..... ................................................ (Complete in Triplicate? Permll No. . <br /> ....................................................... 7 <br /> ........ .......... This Porrnit Expires I Year Fraah st ed Date Issued ... <br /> Application is here ly to the San Joaquin Local Health District for a perm the work herein <br /> described.This applko one s made In compliance with County Ordinance No. 5 44 an xlsting Rules a lonse <br /> JOB ADDRESSAOCATI -6-rZ.f,`�. . ...... ..��F�..�l.'9.�'.][... �.�!"Q.....F2� � ..•CENSUS TRACT <br /> Owner's Name . ..... u ?e r ...................... ................. O� p„ -........................ <br /> Address �rP. l.S �j g .. r .. { .:?.,.!Qcf.. ............Oty T''d .......r......@ ................................... <br /> Contractor's Name..Lc.-I K. r .---•..............................._. ............Limnos# . .. . Phone <br /> Installation will se Reddence;jApartment House C I Commerdal OTroiler Court ❑ <br /> Number of living unit _ •- N roarn>} ` rbageGrInder ......... Eo S e .-•-•....... ...................... <br /> WaterSupply: Public nd ................................_ ..............................-......................................... <br /> Private(] <br /> Character of soil to a 3 fe nd Silt© a p Peat❑ Sandy Loam.0 Clay Loden <br /> Hardpan© Adobe Q Fill Mcterlol............if yes,type........................... <br /> [Plot plan, showingsi of I , location of system In; <br /> n rel to-wells, buildings, etc. must be placed on reverse side.! <br /> NEW INSTALLATION No s ptic tank or seepage V nod If pub c se c5 �In200 feet] � i <br /> f PACKAGE TR M • ] EPTI +MC TANK ] SfYa. .. <br /> ............ ...... ..........._ Liquid Depth <br /> - ..�~.�.— pa tY/� Pe - -•• .. aterlal......... NO. Compartments..- ............ <br /> I <br /> istal tee to rest: Well' ..... ...................Faund i �� ! Prop. Una . ��..'f ' <br /> .............. . ......_..... <br /> LEACHING LINE [ ] .._.. Length of each fine... ..... .. <br /> o. f Lines ............ � Total Length � . <br /> B x . Type Filter Material ....................Depth Iter Material ...._.........................__......... <br /> • , isto ce to nearesh Well ........................ Found', on-.r• ..�..__ ' Property Line ........................ <br /> SEEPAGE PIT. epth .............._. ---•._.._..... ...... k Filled Ya= ❑ No [ Q <br /> ater Table Deptt ...................•---•-... _.................Rock Ii <br /> Size ..._•---...._................... <br /> I stance to nearests Well .................................. .....Foundation .................... Prop. Line ......_..... i <br /> REPAIR/ADDITIONIPrev. ionitation Permit# ............................................ Dots .................................. <br /> } I <br /> SepticTank [Specify Re 4uln menta] ......................................... ----••---..............----.......................__._......_............ J <br /> Disposal Field (Specs Rec juiramenft) ........................................I......•............_ -_..................................................... 4 <br /> •....................-•--.._.......... -- ......_........_.................._.....••------••--•--.........................------........._..._........... <br /> - {Draw existing and required additlan on reverse aldol ... ...... . . ........... .......... <br /> I hereby certify that I h e p pared this application and that the work will be done In accordance with San- Joaquin <br /> County Ordinances, Stat Lo , and Rules and Regulations of the Son Joaquin Local Health District.Home owner or licen• <br /> Rd agents signature ter" as following: <br /> "I certify that.In the orf thn for which this permit Is Issued, I shall not employ nervy peon In such manner i <br /> as rsubject person to ark n' on laws of Califomld." i <br /> Signed. r.. l- ................_..........................Owner <br /> By .........[if <br /> .oth... . .......... 8.. ........ <br /> ............................._............ Title . ..__............................-- . ..........._.................... <br /> f other than ow rj <br /> FOR DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED BY... ..................:.... DATE �- •...�r,�. 7.�`.:::' 1I <br /> BUILDINGPERMIT ISSUED ...... ................ ..............................................................................DATE .......... I <br /> ADDITIONAL COMMENTS........,........._...............•--........... ...... <br /> ................................................ ....................................... ........................._._....................................................._................. <br /> ............I........................... ........._._............ .._....c......._._.......-.....................---................... .._.......................... ...................... <br /> .. ..................... ........................................... <br /> '6n-a- Inspection by: ._.._._ .. � ... ... .. .. .........................................Oats...... ,.-�'_...^�. ... <br /> Eli 13 2!h 1-68 Hev. 5ME .... �... �._..._. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT $��� 3Hi <br />