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APPLICATION FOk SAJNITAJAOPx V�� `1i <br /> � � cz �z z �� / ~ ' <br /> Pnrmi� No <br /> (Complete in Triplicate) ' <br /> ' Dom Issued <br /> ThisPermit <br /> Application hereby made tnthe San Joaquin Local Health District for o permit to construct and install the work herein <br /> described. This application in mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 575- 74......... —^--- —' .- -- -CENSUS TRACT --------' <br /> Owner's Name —. `-- /'�� /��'"^� — ~���z�—`�~��/.l�— <br /> A66nms �"� �.�-. /4^�—' «� ��z� --------------- ------ [ih/ ' phone <br /> -' ._---..`--- <br /> Controdn,'sName ��~��` --- "�' J^� -. ---------- -------License # ��'����w.��. Phono <br /> Installation will wiU uorve Residence E]Apartment Houoe,F Commordo|fe)Troi|mv Court F1 <br /> Mote/ F-1 CVhov ------------------ <br /> Number <br /> -----Num6o, of living units:------------ Number of bedrooms —---------Garbage Grinder ---- Lot Size —--------------- ------ -----' <br /> Wotor Supply: Public System and name --- ------------------------------------ ------ ------------------------------------------------ ---- ------Private F <br /> Character of soil to o depth of feet. ' Sand'[:] Silt E] Clay E] Peat El - Sandy Loam 'El Clay Loam F-1 <br /> Hardpan [7l Adobe&� RU Material ---- If yes, type ---------- <br /> ..0-iowing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit ponmkta6 if public nevvo, i, available within 200 feet> <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size ----------------- Liquid Depth -------_--- <br /> Copodh/ ------' Type --------------------- Material_--------- ------- No. Compartments ------._ � <br /> Distonce to nearest: Well --- ---------- -------------------Foundation ------- Prop. Lina -----_— <br /> LEACH|NG LINE [ ] No..of. Lines -------- Length of each line---------- -------- ------ Total Length —-------------------- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Motaho| --------.---''_—. <br /> Didnncn to nearest; Well —------- Foundation -------- Property Line ----'---. <br /> SEEPAGE PIT [ � , Depth ------- Diameter -----' Number ---- Rock HUo6 Yeo No �] <br /> Water Table Depth --------- --------------------------------------Rock Size -------'--. <br /> Di$nnce to nearest: Well ----- ----------------------- ------.. Prop Line ----- ----------_---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Dote ----------------------------------) h <br /> ' <br /> Septic Tank (Specify Requirements) ------------- <br /> Dixpouo| 'Field (Specify Requirements) ^7..��..��'��—�� /�~�^ /�l !—.���-..-7:'----- <br /> .----------.--------------------------'_—______- <br /> -------------- ----------- -------------------------------------- ------------------------- - ----------------------------- -------------- ------- ---- <br /> (Dnnwexisting and required addition on reverse side) \ <br /> | hereby certify that | have prepared this m9p|/mmdnn and that the vvm,k will be done in accordance with San Joaquin <br /> County OnJinmnce,, S*u*, Laws, and Rules and Regulations wfthe San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> ^| co,h6r that in the performance of the work for which this permit i, issued, | shall not employ any person in such manner <br /> as to become 6jt to Workman's �om uHon laws of California." <br /> Signed '.�e� — -------------.- Owner <br /> By ----------------------------------' Jh|o --------------------------------____________ <br /> (|fothortkon ovvnmj <br /> FOR DEPARTMENT USE ONLY <br /> ---------------- <br /> ����������������'------- ------------------------------------ '---------------'-------------------- ------- ---------------- ...... --------------- <br /> ---------------- ---­----------- --------------- ---------------------------------------- <br /> ------------ ----.—_---------.. <br /> Hno| |n,pochon6y /��x�� ---------'—'`^~,���''���r' <br /> . —=_---.�=�xx�/�«�'_------------------------�Do�o —��� ����^— ! <br /> 5AN JOAQU|N LOCAL HEALTH DISTRICT l7 � <br />