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FOR OFFICE USE: <br /> APPLICATION POET SAMITATIOM PEfIRlY <br /> ............................................ (Complete in Triplicate) Permit No. ....__...-----....... <br /> '. ...................................••..... This Permit Expires 1 Year From Dato lowed <br /> ...• p Date Issued ...................y <br /> Application is hereby made to the Sar:Joaquin Local Health District for a permit to construct and install the work heroin <br /> described. This opplieatian is mads In compliance with County Ordinance. Ale, 549 and oxisting Rules and Regutatiottsr <br /> JOB ADDRESS/LOCATIOi - •_ -� <br /> Owner's N-19lF!1.e _•,__ .e '�%!F�E�.. <br /> .............................. .......Y .CENSt15 TRACT .......... <br /> Addrdis'._ :.. _ .Li `` .....fFF�� �_ .E',r.4! ;•r•_, cr ..............~-.. esf :.....:...:.......Phone .......... .......... <br /> Contractor s Name ..........:... ' ! �' ....:...._..........:�.. .. <br /> tnstaliation e✓ill servo: Residence- - -�_.................. <br /> ..... ..Litenso Z,........:..:........... Phone' ...:::...........�„ _ <br /> Apartment Houso 0 Commordal j]T wkr Court <br /> Motel[]Other............................ <br /> Y ' ' <br /> Numbor of living. units= ......_---• --_-- Number of bedrooms .3-•--•• ....... .......... <br /> Water Supply: Public System and nomo ........ .Garbage Grinder .............Lot.Slzo _ ......................_......... <br /> �_- <br /> .:. .: ............_.._................ <br /> Character of soil to a .... •................... <br /> . !--.Privy <br /> depth of 3 feet: Sand j] _Silt p �C1a - Private <br /> Clay ❑ Peat 0 Sandy Loam fh Clay Loam:[� <br /> Hardpan.W Adobo o FN(Material <br /> If you type . <br /> (Plot plan, showing size of lot, location of- - <br /> } system In relation to wogs, buildings, ctc. ,must,be..placed..an rovmrso side.) <br /> NEW INSTALLATION: (No septic tank or seopogo pit pe <br /> PACKAGE TREATMrmitted if <br /> public sewer is civailabla within 200 fad,} <br /> ENT [ ] SEPTIC TANK _ <br /> capacity.:. ;,• TYPO <br /> Sio Liquid Depth ,. ---.. _ <br /> .. ................. MOW10 ..................... No. Compartments pt a <br /> Distance to nearest: Well .....:.......... .Foundation ,.....�... .. .g <br /> -------•----------- . Prop. Lino <br /> LEACHING LINE [ j No. of Elms ...___- ....�"."'�" -- c2 <br /> -..._..._. Length of each line....................:...... Total �s J <br /> 'D- Box ......"_..._ Type'F"titer material .............:......Depth Filter AAato►iai ..........................._......-s.... : <br /> Distance to nearest: Well ..........._._..._.... Foundation �......... .... <br /> SEEPAGE PIT [ j Depth ...........:. Diameter ...._---- --- - ._..._---- P'�ny Lina"..._.......::..::..... <br /> ..... Alutrtb . ........................... Poled•-Yoe 0 No 0 <br /> Water Table Depth ....:..................-.......................Rock Sizo ........................ S <br /> Distance to nearest: Woll.............................-...._.....-Foundation Pro -;Lino ' r <br /> RGPAIII/ADDITION!(Prev. Sanitation Pormit 0......... ............... .. <br /> Septic Tank )Specify Requirements} .................................. ........................................_.....} _ _ <br /> Dia sal Field fy Require"-.4 } ` g� _�- -. _.. ....................... <br /> _ ._. �.. <br /> ----- -- _. <br /> (Draw ex:stin and re uired addition on reverse sidej� , <br /> i hereby certify that 1 have prepared )Isla application and 4Eaat tl�a Work VAN bo doro in acc6r'Da�t <br /> County Ordinancos. Sento Latint~ <br /> a, .ndillelos and MVuls"no of the Ser.-o jocgtg a 9 i Nc� e.�ee e�ieIt ScSam) <br /> l l�latrk (�eos:to orntcn -f acll -' <br /> sell agents dgnoturo certifies the followings <br /> "I certify that in the porformanco of Cho tjor&-far which'thio permit is issued. 1 shall no0 C:nPlctr a^ay Porten in ouch riicrdvcr <br /> GO to boconto subject to V , mans Coat tt kwm of California.- <br /> Signed.. . Owner <br /> By....... (If other than o"or) - - --------------•------------•-•-•-----•--• Title ......... ..... _..... ....._........... <br /> e <br /> FOA DLPARTMENT use 0AV .� <br /> APPLICATION A »�� <br /> BUILDING PERMIT ISSUJ:DBY. _.. .Ye .............................. ................................ DATE lf..: .�' ............ <br /> ADDITIONALCOMMENTS..._..... �_�.._......___...._....._.._ ---.......................................DATE......................--.....-- -•--•--- <br /> ............ <br /> .......... ........•......I......................_.....^�........ �' :--•.�.... ............... <br /> --- ....: ....... .... .._...-._...................... <br /> ................... <br /> ;:..._................ <br /> Final Inspection by: ............ r ' - »............_. ......._......_.............---------_............._........ .. <br /> -!- ... ......................._....r........_......_. .._..........Roto , ._ ? s�� ,;� <br /> SAN JOAQUIN -LOCAL'HEALTH DISTRICT ' <br /> E.H.13 241.-68 Rov. 5M 7!77 o W <br />