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j%rrs,e%j%jj 2rN rVK 3ANITA1IVINI t'1`XMIT <br /> # '. .....'......................... ........... (Complete In Triplicate} Permit No. .7�.-6 � <br /> y . <br /> .. Date <br /> ........................................................ This Parma Expires 1 Year From®ate issued <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and. Install the work herein <br /> described. This application Is made to compliance with Cou ty Ordinance No. 549 and existing Rules and ice ulat on a <br /> JOB ADDRESS/LOCATION .. / � .......................... .................. .... .......CEN U5 TRACT .'.... ...... <br /> � ._ <br /> Owner's Name ................................... ... ...................................Phone <br /> Address .. 7 .c .... ...��..� City r— <br /> Contractor's Name ..._[cr.�s, r.. �� .......... .............................License's 17 • -�'2-............ - �S <br /> - ... Phone <br /> Installation will serves dance CIjApartment House;] Commercial OTraller Court Q <br /> Mote! (]Other............................................ <br /> Number of living units------------- Number of bedrooms .I.....Garbage Grinder ------------ Lot Size ...........................................% <br /> Water Supply: Public System and name _..........•--•---.. <br /> ... ......__...........-------._............. --•--. __..........--•--- <br /> .PrivCrte <br /> t Character of soil to a depth of 3 feet; Sand❑ Silt❑ Clay 0 Peat[] Sandy Loam❑ Clay Loam C❑ <br /> F Hardpan 0 Adobe❑ Fill Material ............if yes,type.......:....... ............ {/1 <br /> t (Plot pian, 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 seepoge"pit permitted if public sewer is available within 200 feet,) <br /> �# PACKAGE TREATMENT [ ] <br /> SEPTIC K L ] Size................................................ Liquid Depth ..............----........ <br /> Copaclty4TAN--- 'Type .. . Material---------------- . No. Compartments Z— <br /> f Foundation .. Prop. Line -.•..~..~. <br /> �� ��---- ------•------ .................. !c�-- ----- <br /> ..... <br /> Distance t0 nearest. Weil F <br /> LEACHING EINE [ ] No. of Lines --- length of each line-7�..................... Total Length <br /> 'D' Box --.1....... Type Filter Material —...Depth Filter Material . 20 (r...............:.......... <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line .1.............. <br /> SEEPAGE E PIT Depth -------------------- Diameter ................ Number ..........__....___......... Rock Filled Yes'0 No <br /> Water Table Depth ------••..........................••--•----..__.Rock Size ................................ <br /> Distance to nearest: Well ............................ ........... .................... Pro Una ..................._ <br /> �— p• <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................................:.......... <br /> ..ate .................................. . <br /> Septic Tank (Specify Requirements) ......................................... ......... ....---........................---....... ....... <br /> Disposal f=ield (Specify Requirements) ......... ............................. ....................... ......••.............. .................................. <br /> -- ..-• . :_..................._...._ - .. ......._.. ............................................ <br /> _ -------------------•--............... ..---------•-----........----- ................................................................ <br /> (Draw existing and required addition on reverse... . ._. s.ide) <br /> ±--� I hereby certify that 1 have prepared this application and that the work will be done in accordance 'with San Joaquin <br /> I County Ordinances, $tato Laws, and Mules and Regulations of the San Joaquin local Health District.Home owner or 114M <br /> sed agents signature certifies the following: <br /> "t certify that in the'performance of the work for which this permit is issued, I shall not employ diny person in such•manner <br /> as to becom <br /> subject to Workman's Compensation laws of Catifornla." <br /> Signed ._. <br /> �. ........................ Owner <br /> -. <br /> By .......--•--•..... .................... ...................... . ........_.._ .. title ............................... <br /> . <br /> l f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> I� BUILDING PERMIT ISSUED ........................•----•-•--............._.. ..... ....._.....-... .-DATE _..:_.......... <br /> ............... ..ADDITIONAL COMMENTS .....................:-------- --•--------------•----------...---._..--••-•----•-•-••------•---.................._.._.._..------..I..............I._......_... <br /> ...................... --• ....._..........----------•---. .._.._..•-----.......•----.------..........._....--...----------••--........................ <br /> -41T ._.:. ............. . <br /> Final Ins action b �.._..Data: " � " .... <br /> `c- EH 13 2!t 1-68 Rev. SAN JOAQUIN LOCAL HEALTH TRICT $/A 3M <br />