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f 3 <br /> •:fit .4n T9"{:J'1 �r�. -. 'v�+.� .,_ �: _ -. _ x.-. .,.$t✓-'M'nx.•v-.LNr ��+*�+wI�Y �, r <br /> ro�Yf FOR OFFICE USE: <br /> f APPLICATION FOR SANNATION PERMIT <br /> Per i <br /> S+a iCompleteinTripllcofet <br /> < � ..... ...:... <br /> Mr Dote sssuadY� ;:; ...... <br /> ay This Permit Expires 1 Year From Dote Issued " <br /> 'Xfi�rrvt <br /> Application is hereby mode to the San Joaquin local Health District for a permit ra conrtrvct and install*tlte� <br /> described.Thi3 application is made in compliarce with County Ordinance No. 544 and existing Rules and Rpuhsfhet <br /> JOB;ADDRE5SJLOCATION P �-.�-r ... ......... .. CENSUS TRACT 4.� <br /> Mm r <br /> ..... +�-✓ PI>eM > <br /> r ,f c , <br /> v ity <br /> Z - Address �-P :�:;.� ,. /.}. .......... <br /> iV: .. �" <br /> <� .....license# �d 3 y. Phots <br /> '-"'4-r Contractors Name L .a...�d.. ......... ...:...................:.. <br /> iI`itisfallotron+Mill servei Residence A artment House 0 Commercial oTraller Court ❑ ="� <br /> p <br /> ,, lJlotel�father_ ......: ...........•.. <br /> Number of living units-.... .�.. : Number of bedrooms .Y... .Garbage Grinder lot Size <br /> Water Supply: PubhC System and Home .........................................•..:. .......... F►ivofo f K r <br /> k'f c Ct oracter of soil fo o'depth of 3ex <br /> fent: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam (� Clay loom <br /> Hardpon❑ Adobe[) Fill Material <br /> ...,...... <br /> If 5,1) <br /> i <br /> (Piot plan, sh,�w1np size of lot, location of system in rotation to wells, buildings, etc.,mustbe plat l _ <br /> NEW INSTALLATION: {No septic tank or seepage pit'peimitted if public sewer is nva�lobie within'L00 ,�s <br /> }: squid ,i)epfh <br /> Size <br /> PACKAGE TREATMENT ( ] SEPTIC L4NK� ) <br /> ........... No' <br /> . Ca-,.Material.....Capccity ................. Type .. t acs <br /> Foundatiat........ ........ Prop. lirts ....: <br /> f: Di.tonce to nearest: Well ... <br /> "�• ... Len It of each line Tot <br /> ' O No, of Lines <br /> .•...,... a1 Length <br /> LEACHING LINE ..... <br /> ' D' Box Type Filter Matorla ....Depth Fllter Moterlol� <br /> to neare3tr Wall Fa-ndation ......•. :....I. . Property tins <br /> Distance ••• <br /> r Nvmber ,.. <br /> SEEPAGE'PIT ( ; Depth <br /> ..... <br /> Diameter <br /> Rock Filled Yes NpQy <br /> T� .Rock Size <br /> Water Tcble Depth .. <br /> P Foundation ......... rap, <br /> Line <br /> ,. Distorto nearest: Well <br /> ...... <br /> xz <br /> N£ Date ....... . .......•............ ) <br /> REPAIR/ADDITION(Prev, Sanitation Permit# <br /> Septic Tank (Specify Requirements) <br /> .,�.� <br /> d <br /> Disposal Field (Specify Requirements) ••• ....r. .,. .. <br /> .......................... <br /> ..I.............. <br /> e z <br /> (Draw e i ng and required addition on reverse s?de) <br /> I herby unify that 1 have pAl <br /> repared this application and that the work will bo dere in accordance with San Jeaq R' <br /> r" I her Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health DlsMct Heats etsnter sr►Ilassr• <br /> County _ <br /> sed agents signature certifies the following: In sbds iNsttster, '� <br /> I „ <br /> I certify that In the performance �f the work for which this permit is jssued, I shall net employ 4ttY fM <br /> as to become subject to Workman j Compensation laws of Caiifarnir�." <br /> t} <br /> ............... <br /> r <br /> r� <br /> r. Owne � A <br /> ......... .... . <br /> :. .... <br /> Signed ��!!f!� / �.��!`rXX.�y'S�.-.. Title . a "r,!-moi' . "ter <br /> B ............... <br /> f y..... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ...................................................................... DATE <br /> APPLICATION ACCEPTED BY................. <br /> DATE ..... '2� <br /> BUILDING PERMIT ISSUED.................................................................-..................................... <br /> .. <br /> ADDITIONALCOMMENTS.................................................._..............._......................................... <br /> -., ...............•...........,,...�....s...��...}....................... ................................. . <br /> .:.............. ...........5.r.l.=.............................................................................mss..: ,j�a2/ 5'., n r <br /> Final Inspection by: ......................... a <br /> SAN JOAQUIN LOCAL HEALTH DI. ..ICT z = <br /> r . <br /> 7/7Z 3 K - <br /> 0 <br /> ' E.H.13 24 l-'68 Rem 5:J1 <br />