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1 n <br /> any <br /> FOR OFFICE USE: <br /> APPLICATION FOR SAWATION PERMIT 7� <br /> .. Perm it No, <br /> -71l S <br /> (Complete In Triplicate) <br /> ............... <br /> This Permit Expires 1 Year From Date Issued t <br /> Application is hereby mode to the Son Joaquin local Health District for a permit to conttrvct and install the work herein <br /> described. This application is made In compliarce with County Ordlnor�ce No. 549 and existing Rules and Regulat(onsr r. <br /> JCB ADD2ES5/LOCATION .r� .6 �-.G s., .,� ,mss/ ..1...."L _....... ............. CENSUS TRACT <br /> Phone ............ ...... <br /> Owner'. Norte ....../6G1.:d... N e>' ' 1. .+ '^ ........................ ................. <br /> !tV}.., sf� City .....fi. r....... <br /> . .......... ... ......... r <br /> ' Address ................2 .0.�:�.,5........... ............................ <br /> q- 7 <br /> ContracPor`s Nome :..:��-.+..,��.:.{. ..... -s......:............:........ .......license# �d 3..A.y`. Phage . ,...:..., , <br /> ........ . . <br /> installation will server Residence Apartment House Commercial QTroller Court Q <br /> Motel Q father. ....................... ................. <br /> Number of living uni!c...../..,. Number of bedrooms . .'.....Garbage Grinder ..........., lot Size .. � `'�'' • ` , <br /> Water Supply, Public Svstem and Home <br /> Privote <br /> f soil to a depth of 3 fart: Sand Q Silt <br /> ❑ Cloy ❑ Peat b Sandy Loam e' Clay loom[� <br /> Character o Hardpan Q Adobe Q Fill Material............Sf yes,type—..: ...:,. <br /> (Plot pion, sh.rwinp size of lot,;location of system in relation to wells, buildings, etc. must be ploreed on rMrsst. <br /> NEW INSTALLATIONt (No septic tank or seepajo p;t permitted if public sewer is ervallobw within 200 feet,)# <br /> PACKAGE TREATMENT ( J SEPTIC TANK; ] Size................................................. Liquid Depth ...... <br /> - Material...................... No CasiP0MrWnts .... <br /> s Copccity ..... ........... Type .................... <br /> arest, Well ....................................Foundation.............. . ... Prop,lime <br /> Oiaance to no <br /> ?. <br /> LEACHING LINE O No, of Lines ..... length of each line ......................... <br /> Total Length <br /> Depth Filter Motorial .. <br /> 'D' Box Type Filter Materta p <br /> Distance to nearests Well . <br /> ... Fovndatio�n Property Line 4 <br /> " Number .... Rock Filled Yes [j No 0 <br /> O <br /> Depth <br /> Diameter ...... <br /> SEEPAGE PIT P ............•....... r..... <br /> :Rock Size <br /> Water Tcbte Depth <br /> Pro LIM ........_... : 2 <br /> Distoncr to nearests Well .................Foundation ..................., p. <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ....................... <br /> ...........) <br /> Septic Tank (Specify Requirements) .................................. <br /> D,sposal Field (Specify Requirements) <br /> ...... <br /> �1 d <br /> ... ........ ................ ... r ... ..... .. <br /> .1.. (Draw existing and required addition on reverse s,de) <br /> v 1 hereby certify that I have prepared this application and that the work will bo den* in attendance with Sat 'Jeesgrlsi <br /> County Ordinances, Stott Laws, and Rules and Regulations of the San Joaquin Local Health Dlsldcf. Monte owner w N <br /> sed ogtnts signature certifies the following: iw suet, r�tsnow <br /> .,I certify that in the performance ^f the work for which this permit is Issued, I shall net en+pl*y qwy Per"" <br /> as to b*cem* subject to Workman'e Compensation laws of Califernin." <br /> ............:.... Owner <br /> Signed ........ .r <br /> q <br /> By ...................... ��.!YGc... ...... <br /> (if other than owner) Q ' <br /> FOR DEPARTMENT USE ONLY <br /> DATE .... <br /> APPLICATION ACCEPTED BY7777. DATE <br /> f <br /> BUILDING PERMIT ISSUED ................................................................._...................... , .. <br /> ADDITIONALCOMMENTS ...........................:............................................................................................ .. <br /> ..................................................................................................... ............................. ................. a . <br /> ... <br /> ...................... <br /> ...........................,�s �} Date ....,�/ ,7 .............. <br /> FinalInspection by: . ...........................�r l." .............................................................................. <br /> SAN JOAQUIN LOCAL HEALTH DI,° .21CT ' <br /> 7/72 3 M <br /> ;. <br /> I. E. H.13 24 1-'68 Rev. 5;A <br /> .�-.- ,_i�:�°<<.�•..-_? . y:as� i1�]'►�"�„ .2�?.0§�G�IR%. '1.�`r�"rsl�.�r�C �t� ''��J'.ei�"�'i3�B`�E6�8`:�,sd9�lf`� 9�1�`.�,�ili'�l�tk - <br />