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M <br /> f - WMIRIx.:..: <br /> FOR OFFICE USE: <br /> .... .................... <br /> AMICATfON. SANr, ..i4N P '.r.' i l <br /> ......... ..... ....... ........................... <br /> It:etap1e40 in Triplicate) Permit No. ... ._ <br /> ......................................................... This PervroitExplrw T Yom From Deft isaatc�,C <br /> Dc"issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instair tale work fv**In;. <br /> described.This application Is/made in compliance with County Ordinance No. $ASSond,existtny Rules and Regu4ott a <br /> JOB ADDRESS/LOCATION /tel/ �'` /y t:'.�f..I. C%... .... cif r�i /� CfMSi?S TRACT .C/ .. <br /> Owner's Name - ../L,! .h......11i'I,lSC": r./�!.. ............PHoe+e.Js7./.--.��J. <br /> Address .. ....�'w,Gr?�.1/�,!�_N.t-�L ....CXR 1..............................City ..: <br /> Contractor's Norne ............... . .......................Lkense# .... ............ Mone -------------------- <br /> Installation will serve: Residence'dApodment House{]Commercial Trcr'IarC4urt 0 <br /> Motel❑Other......................................... <br /> Numlnor of living units,—/...... Number of bedrooms ............Garbage Grinder Lot She ... .. <br /> Water Supply: Public System and rtame ........................................................_................................................ <br /> ...Pei otat <br /> Character of soil too depth of 3 feet, Sand j] Slit❑ day ❑ Paas❑ Sosr: iY loam❑ Clay Las:m❑ <br /> Hardpan❑ Adobe❑ Fill Mabrlal............V'yes,type........................... <br /> (Mot plan, showing size •;f lot, location of system in relation to wells, buildings, etc. must be place an rv%VPW <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is cwaiiable within 2000 feet,l <br /> PACKAGE TREATMENT ( ] SEPTIC TANK{ ;f>r 1-i'/t••S iza;... ..... .. .. . ....... Liquid Dwh .. ...................... <br /> Capacity / �rG�.... TypsZ.rr/t . 'hiMaterial.� .yj�.('t. i+Dc. Cam;s°trtm•rrh .s .� <br /> /r' Distance to nearext: Well " ........ .Foundation ..,�G._.J.........Prop.Line-_ ?` , <br /> f <br /> 'y �; ........... Total Length ,�4 <br /> LEACHING LINE ( } No. of Lines ...�................ Length of each li .....�j�G'. r/ <br /> Box ;7- . . Type Filter Mafera/ Z..7 Z.'.` cLdr <br /> th Filtytr M.ater{ai....�.`�..:.. <br /> G Foundation .... C.' Property tins .. <br /> r� S Distance to nearest: Well ......^ .... <br /> SLj n'i <br /> t <br /> ' .... Roel Filled yip.)< <br /> T 1 Depth ....�G>....... miametttr �.8. ....:. Number ........✓:. .. _ i <br /> L �....~..�..� ....... J <br /> Water Table Depth ..........._��............................Rack Size / ,� <br /> .........................Foundation <br /> Distance to nearest: Well .---.5 /'rG ......... }rap. LLne :7� J <br /> .... <br /> R1EPAlR/ADD1T10;!IPrnv. Sonication Permit ................. Dans - _ .... j <br /> .. .... ............. <br /> ti Septic Tank (Specify koqurremenis) .__... .. ...� - r <br /> Disposo( Field (Specify Requirements) ..../�'.„� :fLl'....... ... ...y '. ,.: -..••. f ,r`� <br /> i4. _ .... . ......_.................. . ....................-. <br /> .... ... .... .. 1. <br /> - - (Draw existing and required addition on reverse;'''s ) <br /> htet,.by certify that i have prepared tleis application cad that the work will bo ,°eno in oece+ct. :vltlt See+ �`� <br /> County .Ordinances, State Laws, and Rulos and Regulations of the Son Joaquin La"I Health District.Flon+e eweeer <br /> !I <br /> sed cgentr signature certifies the following: en la such"i certify that in the performance of the work for which this permit Is Issued, 1 sholi "ot employ any pev <br /> } jaficn laws of California.” <br /> 9 become ��jfct�fo Workman's Com�eln '7 i <br /> «LLL/ , if <br /> —' Owner <br /> as e <br /> BY <br /> d�. .. . <br /> (if other than owner) <br /> FO DEPART .. <br /> ,.-r. <br /> i{, ENT USE ONLY _ <br /> .. DATE <br /> APPLICATION.ACCEPTED BY . <br /> BUILDING PERMIT ISSUED ;r <br /> ADDITiONAL COMMENTS _ <br /> } , ectro'.. . . Dote <br /> eras 1r .f✓, .' .. .... . . .-- <br /> p n by: . .... <br /> �I N rOAOUIiI <br /> •LOCAL HEALTH D+STRICT 8/7h 3 <br /> Eli 1- 2L . 1 �� ; 2<v ';. . . <br /> MA <br /> .�i <br />