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�rd-�iar�nnvry F-VK 1ANF? A119jN PERMIT <br /> (Complete in Triplicate <br /> Permit Na, '.... <br /> f i=� <br /> •............................................... �J�- .. <br /> .......... _. _ This Permit Expires 'I Year From tato fasued Data issued <br /> F4 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 In compliance with Cou ty Ordinance No. 549 and exlsting Rules and Regulations: <br /> I <br /> F JOB ADDRESS/LOCATION .. C� ..:._ ? � ........CENSUS. TRACT t <br /> Owner's Name � ? .... .......... . .........................._.........Phone . :.. <br /> Address ._-........ <br /> Contractor's Name <br /> d---/.P.- f-- -• - - - ------------•--......-- --..License �.� ...�.. Phone �� ..... <br /> Installation will serve: dance j Apartment Housed Commercial❑Trailer Court 0 <br /> Motel 0 Other I <br /> Number of living units:............ Number of bedrooms Garbage Grinder Lot Size r <br /> Water Supply: Public System and name ..Private " <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Q Peat❑ Sandy Loam ❑ Clay Loam p <br /> Hardpan p Adobe❑ Fill Material ............If yes,type........................... <br /> (Piot plan, showing size of lot, location of system W relation to wells, buildings, etc. must be placed on reverse side.1 i <br /> NEW INSTALLATION: (No septic tank or seepcige'pit permitted If .public sewer is available within 200 feet,; <br /> PACKAGE TREATMENT [ SEPTIC TANK f j J Size_...... Liquid Depth <br /> kt ! ---•-••................................ -... - <br /> Copadtyl,26. .._ -_.'Type .. Material...................... No. Compartments <br /> Distance to nearest: Well' ...1.,�1q-1-_ --foundation .._ Prop. Line <br /> LEACHING LINE [ � No. of tines _�J`�............... <br /> g , Z�4 _ Total Length �-1 .N <br /> .____ Length of�eayc�h line_ � <br /> 91((f ...Depth Filter Material ..L�l .. <br /> 'D' Box ... ....... Type Filter Materia! . .-•- --•- __-- .............................. <br /> Distance to nearest: Well ------------------ Foundation ------------------------ Property Line ....................... <br /> SEEPAGE PIT [ ] Depth ------------ Diameter <br /> ---------------- Number ------....----••---. ........ hock Filled Yep ❑ No <br /> R <br /> Water Table Depth ....-----------------------------.--------------Rock Size •--•--•--..._....-----=---••---- <br /> Distance to nearest: Well ........................................Foundation ----------- ........ Prop..Lina .............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit --------------------------------------- Date ----------------------------------[ <br /> SepticTank (Specify Requirements) ...... ............................................................................... ....... .............................. <br /> Disposal field (Specify Requirementsl --••.............•-----•------......_...-•-•••-•--.....----•---------••------------..._..._.....----------- ....... ........ ..... <br /> - .._:. ....... __.._... _..:. <br /> --•--------------------------•----•--..-----•---------------•----.•--...-....---•--....-...----------------•----------------------•----- -•-----•--- .... ....... ........... <br /> . <br /> ..--• •--------------------••-•--•----•--•----•--------------••-..... .. ...................................................... ......­-------*---------- ---------- <br /> (DrawDraw existing and required additions on reverse side) <br /> L ' I hereby certify that I have prepared this application and that the work will be done in accordance yAth San Joaquin <br /> County Ordinances, State Lawns, and Rules and Regulations of the San Joaquin Local. Health District. Horne owner or Iieen- <br /> €ed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such mannei <br /> as to becorng subject to MWorkman's Compensation laws of California." <br /> Signed ... <br /> Owner <br /> ----------------- Title <br /> Fil (lf other. than owner) i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By -------------- ---................I.......... ........ . .. •... DATE ....... <br /> ...- <br /> ` BUILDING. PERMIT ISSUED ---•---•.......................... • ... ...... ..........DATE ....,.................... <br /> :. <br /> ADDITIONAL COMMENTS ------- .._...--------------------------- ................................ <br /> -------------------------------------------------------------------------------*-----------I----------1-1------ ---------------- <br /> I'll <br /> -------- <br /> •--- <br /> •.....----. •......................................... .._._:. <br /> •-------- ------------------•-...........------••... .__........ ...---...--.-----..._....._...--•--•----._..._...... <br /> Fi ..-•------------------- -•-•--.... .---- ----•----....._.._....----.--------------- -•--••-•-......._.. ..... --- .--... . _ <br /> .... <br /> Final Inspection by: ......................................._....._....------...---.........----......__.........�_.. _. .....Date ._.......`.. ......�' ............. <br /> ��-----------...... <br /> Fli <br /> EH 13 2!t 1-60 Roo- q4 SAN JOAQUIN LOCAL HEALTH / TRICT 8/7h 3 <br />