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��.............................................. - - (Complete In Tripfkate) � Permitlwlo. ...��.���.Z <br /> -- Date Issued .Z <br /> _. This Pennit Expires 4 Year from Date Issued '- .. <br /> Creby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. Thi XffitvKon is made In compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> -JA ..................*........ <br /> ..........-`.............. .a�:..............CENSUS TRACT .............. . ... <br /> -L jN ... -t._..-... fhaOwner's Name :. t . ...... ....•- ............................... na <br /> _ ........... <br /> ................-C �Addres ... <br /> Contractor's Name..............J� 12 .. <br /> ---•- --------------.License � .:'.._ .w� `� .. Phone� :�..:�f'�.. <br /> -� installation will servac.. Residence artrnent House Commercial❑Trailer Court � <br /> Motel❑Other............... - <br /> ' Number of living units:_._._ Number of bedrooms _._Garbage Grinder Lot Size .- <br /> Water Supply: Public System and name ........... Private91 <br /> ' <br /> Character of soil to a depth of 3 feet: Sand Slit❑, Clay ❑ . Peat© Sandy Loam 0 day Loam Q ' <br /> Hardpan❑ Adobe❑ Fill 14�aterial.._.........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 INSTALLATIONS (No septic tank or seepage pit permitted If public sewer is available within 200 feet,} <br /> s PACKAGE TREATMENT [ SEPTIC-TANK ju-- ,`;. Size..........e-".:�..- ........_.. Liquid Depth .................. <br /> ' " .._`'.... Aaterlai. .:f. No. Compartments------ Type ------- <br /> ------ •------ . <br /> Distance to nearest: Well'- -----N111- _-..,..Foundation _: ......�.. Prop. Lina .,. . <br /> T <br /> LEACHING LINE [4-- No. . . Lines :.... •--- ..--• _ Length of eods iine. .r--.----------7....... Total tengtlt_.� .... M. :... v <br /> ._:. <br /> `D' Bax __.: Type Filter aterlal . .` 'repth Filter Material .T J............. ..:.. tj <br /> - <br /> - - -- -- ......_.... Property L ne �....:...��'' . <br /> Distance to nearest: Well �- Foundation l ! <br /> SEEPAGE PIT: E j Depth .................... Diameter -.--------_... plumber ............................ Rock Filled- Yes ❑ No 0 <br /> i _Water Table ......---------- ---Rock Size W <br /> Distance to nearest:Well .-Foundation. Prop. Una <br /> ii EPAIR/ADI]lTl4l+t(Prev. Sanitation Permit ..................--.-...........__.....- date <br /> Septic Tanis (Specify Requirements) ................_........^-----....-- ----------------:.:.......... ............. ...�..:...-..:........... <br /> Disposal Feld (Specify Requirements} --.....----------....._.----_. -----------.- ..... -..... <br /> --.................... .....-•-........:_.._--- ....-...............­1._..�...............-----_.....--:-....--------------_................................................_.---------_........-•-------- <br /> - ........_- ..........................._...._.._.._._.. Draw existing and required.... .addition on revers.............. ......sidel . ............. .....�...... ..._.....,..._.... <br /> I hereby certify that II have prepared this application and that the work will be done in accordance with Sass Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home evmer or licen• <br /> sed agents signature certifies the fallowing: <br /> "I certify that in the performance of the work for which this permit is Issued, I shalt not employ any person in-such scanner <br /> as to becom sfpr 'blect to W r-6an' ampensat#on laws of California" <br /> J � L � 4 <br /> Signed -_. ...._._................ ........... ..._.---. Ownery <br /> By ............... ...... ��..............•---------- dale .............-._................ . . ---.._.. ....................... - <br /> If other than owned <br /> FOR DEPARTMENT USE ONLY <br /> UAPPLICATION ACCEPTED 9Y �.�.... DATE ...�Q.- s �.:............. <br /> ----- - ------------------------•-------•----.-...._.._....... <br /> BUILDINGPERMIT ISSUED ...............:.....:........................................-.---........_. . ..--------.......----•-DATE ................................._........ <br /> t ADDITIONAL COMMENTS -----_--...:._......... <br /> .........................................-..__..........................-------....--=--•---•----------------------....._...._..._. <br /> # .....................................................................................................................- .............._....._.•.....---------.._. _...--•----=-•--.----------- --- ...------- <br /> Mi 13 24 148 &V. 5H SAN JOAQUIN LOCA HEALTH DISTRICT 8/7h 3H <br /> e.Vn� ,gyp �- 7 -mac <br />