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+ ` FOR OFFICE Vim' FOR OFFICE USE: ` t <br /> st <br /> APPLICATION FOR SAN);flTION-PERMIT p 6! f <br /> _a......................._......_........_......._..... t"" <br /> •••• <br /> (Complete in in TriplieateV -- <br /> Date Issued.J-.;LJ 77Z r <br /> /I----•----------_•--------..............._... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is melde in compliance with County_Ordinance No. 549 and existing Rules and Regulations: <br /> BB I <br /> JOB ADDRESS/LOCATION........�1h. sS.+. rWIPJ IPIPQ/5�....,--�QP-F--_�---CENSUS�TRACT...__.._._--..__......._'--- i <br /> Ov✓ner's Name_'.- xUR---.-----VAN.- .1.4 ................ : .... ...._ _...._. . ............................... <br /> Address .. - �- _ <br /> esi( .( � iy..... ........._!...... <br /> .....io-neZip..................... <br /> s.r <br /> - ........ <br /> Contractor's Name_! ... . ......___ ._-.....:... . _._.._.. _ Licm #......_-.....E._. <br /> AparM»nt oga al ' Trailer Court*QInstallation will . <br /> t <br /> - <br /> I <br /> Numberot.living unlIS:._ . ... .....Nums, <br /> �r..•fflbedraism _3----.Gar 2geGrinder.....­._LotSidi ...... <br /> t <br /> Water Supply, Publj Ste l nd nome.� ..._..._._.,.i. -' -�--...-'--'-'-`...._� .- Private <br /> Character of soil to a depth o 3 feet: -t Sand ❑ Silt❑ t7a� Peat(. Sandy Loom C Loam 0 <br /> i - I <br /> ^ rdpon , Adobefl Fill Materibl...�L.....lf yes type......_`.. ................. 5 <br /> (Plot plan, showing stze of lot, location of system in relation to wells, buildings,L;ewerh <br /> etc,must be place -14 n rqaerse side.) <br /> NEW INSTALIATIGNi�J]No septic tdnk\ 1�eepage pit permitted if publis available withv.20U feet,) <br /> NT [ L SERTICTANKJI'1 <br /> PACKAGETREATME, iquid Deci T !�C ..,�ater{ol- :.._ _No. Compartments.f.................., -:----• ip ------�- <br /> ',. tsroncero trestr1Ne11-... �j. -..t .......b. . ....., an -Prop.-Eine... --- <br /> LEACH�INa GNE: I 1 J�. f Linet .[o •- -. ,-;.-:-%Long .�1 Ifrw.. '1 :.........:.:-. MI length... Y sD <br /> D' Wox.f....... Tape terMaatterial, /�y�y/_I/���Depth FilterrMatmi ___X -------------------------------- .. <br /> Di-tana6tOn'arest:�Weii_,./ +..__A!OUndatlan.__.rT._ .,i_.____'-_...Firapef}y ne.i.._.. ----__.1... <br /> SEEPAGE PITror.-.. <br /> UiBme -. ........Number. _. j Rock Fi ~Yes o No p � <br /> .. <br /> Water Table D1�fh...,.............. '1\g�i—�1J<.,....Rodc ._. .............w_.. .----'-.. <br /> ��yy. �'-� <br /> Disfonce,fo nerl :F'V�I_,._.:_;_____._.-----..._.._.__:_._Foundation._. __ _. _..._....:_ _ <br /> • _ <br /> R@AIR/ADDITION ( :Sanitation dot _ .:__>._..r .......t...._ ---------- <br /> Septic Tank (Specify uirameMs)..... . ..,...__ a.:.,.... ..:q... %' - .......... - ----- -------- ------ <br /> f ^ <br /> Dtporal Field (Spec fy Requiremients :............:.................................................... ........................__...... <br /> I <br /> . . ....... -r'-- . *..._......•-.�......:........ <br /> r <br /> .....I.......__....... .__...... ................ _.._----'-----_._...:.. <br /> t t t V-(Draw azisting Arid required addition:on reverse sidel ' <br /> 1 hereby certify that"l have prepared this applicationandthat the work will be done in accordance with Son Joaquin County <br /> Ordinances, State Laws, and Rules and Reyulations of the San Jo Diltrict, Home ewnir or licensed agent j <br /> signature certifies the following: <br /> i <br /> ••1 certify that in the performance of the work for �w.�hkh_thls_pornitf 6 V"-- •1 slwlf� employ any penM <br /> eL In such manr on <br /> to become sobjectt W man' o:npensoHon�Z',^ of Califomia'. . : - <br /> Signed �i4 ��O{{`��"rn��elJ <br /> By.•._... _ _.- ..........S. :_. .�..TiNd. - _ . ..�--- - It <br /> 1 pf other than) <br /> PARTMENLY <br /> APPLICATION ACCENTED BY---- ---�. <br /> ........: ...... _...-.....__...........:_..--- . .-- ---------------- -----------(--- ----------.-.-DATE .... tl <br /> ........... <br /> - <br /> .---- <br /> DIVISION OF LAND NUMBER:......:..:. .................. ............DATE -------------------- <br /> ------ <br /> ---- ------:-)-... <br /> P^OITIONAL COMMENTS............. ---_..------- <br /> - .......... ..... ---------- ................................. ...... <br /> - <br /> ¢ <br /> .._.♦. ...Dale._ �..-... <br /> Finul•Inspection by:.:.r.._..-. --:"- -- _�SAIJIAIUIN <br /> '...............-�__..-.. .. �_ .___ � .. ..:....... <br /> rM !t 141st 21 rlv.I sus J <br /> LOCAL HEALTH DISTRICT <br /> alp-. .+- / I ff <br />