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F## nPPLICATiON FOR S ANtr,1-:Tl10N <br /> i. <br /> # f�.amxzFete ire sr.p€icaF�# <br /> . ...............F <br /> - -- - .- ----- This Permit Expires ] Year Frew, Date issued <br /> Date Issued .. - -3- . <br /> - - - <br />{ Application is hereby made to the San Joaquin Local Health District for a permit to consiru'ct and install{ the work herein <br /> i described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LO � � rCA IO ° . .. � Cr SUS. CliNSUS TRACT .... . <br /> Owner's Name . �----- ... ........... ........... . . . Phone <br /> r yAddress -��;_,4- ;. ��-�..��-¢s.r�-c_ c�.-L� --.. . . .__ •--...., C•st �.,- �=%i- .. .. .. ._. .... .. ......... <br /> r Contractor's Name ..-_ .:............_License k f .; .... Phone .. <br /> ................... <br /> Il Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other ------------ ------- -- ------ ........... <br /> Number of living units:..... _-.-- Number of bedrooms --.-------Garbage Grinder -.. ._ ..... Lot Size ......................-........------------- <br /> P Water Supply: Public System and name ------------------- ................Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [) <br /> y Hardpan Adobe ❑ Fill Material ------------ If yes, type ............... .......... . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK [ Size- / .-- --1....Wit:--- -•.......... tiquid Depth ............... <br /> Capacity Type _iL-{z ..-- Material-. z-y_ti... No. Compartments ....•............� <br /> Distance to nearest: Well ----------�--p----------------•Foundation ....--1-_£_'-....-.._ Prop. Line ..- ................� <br /> LEACHING LIME [+j No. of Lines -------- -------- Length of each line----... .-.--- Total Length ... .......... <br /> 9 a 'D' Sox -...� ----- Type Filter Material ... '- -- .Depth .Filter Materia! - f. .................................. <br /> Distance to nearest: Well ------ .. -.- Foundation I °°.-f..'.- ---, .. Property Line ---------.----.---.----- <br /> SEEPAGE PIT [ � Depth ---- �_I---I .Diameter ----. - -a- Number ...--.--...- _.-------- Rock Filled Yes Na iQ <br /> l Water Table Depth -----------I..Q.Q i - -------------------Rock Size ---)16.- <br /> Distance to nearest: Well ---------- - - -- -----------Foundation _C 6- 4_ r <br /> -.... Prop. Line ...................._ <br /> REPAIR/ADDITION¢Prev. Sanitation Permit 9� -------- ----------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) -------- ---------------------------------------------------------•-•-----------------------------•-----•------ -•----_----------- <br /> Fl; <br /> Disposal Field (Specify Requirements) ------------- --- ------------------------------------------ --------- ------------------- ---..__. •...--.--.I <br /> ` ......................................-------------------'-----------------------'------------------------------------------------------------------------------...-----'--------`-----------------------. <br /> ------ <br /> D row existing and required addition on reverse side) <br /> I F ' I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin <br /> County Ordinances, State Lawns, and Rules and Regulations of the Scan Joaquin Local Health District, Home owner or licen- <br /> sed agents signature certifies the following: <br /> l I "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> . J <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed � -- �- _�..-.._f - �---------------- ------ �� ��-� <br /> ... .......- "" <br /> Owner fx <br /> BYE F- _ -: Title .....Y . ? ! .t <br /> < <. <br /> ......:r... .. ......... ......... ......... <br /> (If other than owner) Y <br /> -- ___— --- ---- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 13Y ... ..... ..__ DATE. <br /> BUILDING, PERMIT ISSUED .... _ .-.. .. . .. ..... _DATE <br /> ADDMONIAL COMMENTS .. -.-- . . .. <br /> ?i6tl may: -- "L� ... .. - D,. <br /> Fine . e .. <br /> �= <br />