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Permit No. .J�.....�. '.'. <br /> (CemplefelnTriplicate) Perm •••••• <br /> . . .. ... . <br /> This►etwslf Expire. 1 Year From Deft bawd <br /> Date Issued .7".<.�...�.�. <br /> ,licotion is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein <br /> ribed Tiris application is made in compliance with County Ordinance No. 549 and existing Rules and Regulatlonsr <br /> ADORE SS/LCCATION <br /> CENSUS TRACT ...... . ..... <br /> ler's Nome .,.......... X <br /> less ty �J!� ll�f��' <br /> .................... <br /> Tractor :Nome /,Z-/. ; `'.1. ll`... KIi/5-...S!r.lk»rtse f ,��.?. Phone ..4 1 <br /> illation will served Residence®Apartment House❑ Commercial❑Troller Court 0 <br /> Motel ❑Other............ .............................. <br /> •ober of Irving units: Number of bedrooms ....f.....Garbage Grinder /A'.. . Lot Size . ..Z. ..���.....�........ <br /> or Supply, Public System and name . . ...... ............................................._. ........Private Ca <br /> ........................................... <br /> ratter of soil to a depth of 9 feet, Sand Q Silt C] Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe ❑ FIII Material ........ ... If yes,type............... .......... . <br /> t plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) g <br /> Y INSTALLATION: (No septic tank a seepage pit permitted If public sewer Is available within 200 feet,) <br /> KAGE TREATMENT ( J SEPTIC TANK( ) Size.... ................... ._ ........ .... .. Liquid Depth ..........................'(t <br /> Capacity Type .. ................ Material........ . ......... No. Compartments <br /> ...................... <br /> Distance to nearest, Well ....................................Foundation .. ...... ..... ...... Prop. Line .......... .......... <br /> THING LINE I J No of Lines , length of each lino Total Length .. .... ................ <br /> 'D' Box Type Filter Material . . .... ..........Depth Filter Material . <br /> . ..... ...... .................. <br /> Distance to nearest: Well .. .. Foundation Property Line . ...................... <br /> 'AGE PIT ( J Depth Diameter Number Rock Filled Yes (, No Q <br /> Water Table Depth ... ...................,.......................Rock Size ... . . ... . ......... .._. <br /> Distance to nearest: Well _......... ..................... ....Foundation . . . Prop. Line ..... ................ <br /> AIR/ADDITION(Prev. Sanitation Permit* ........ .. .. 1. Date ........... .. .. ............. ..) <br /> eptic Tank (Specify Requirements) ....... I ......................................................... ........ ..._.......................... <br /> isposol Field (Specify Requirements) ,2//1..'� . ........... . <br /> / 44�1.4 / '. _... .. . _.. _ ..... .... . ............. <br /> (Draw existing and required addition on reverse %idol <br /> reby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin <br /> rrty Ordinances, State lows, and Rules and Regulations of the Son Joaquin local Health District. Home owner or (Icon- <br /> agents signature certifies 11,9 following: <br /> ertify that in the performance of the work for which this permit is Isss-rd, I shall not employ any person In such mannas <br /> o become subject to Workman's Compensation laws of California." <br /> ed ., Owner <br /> .-/ <br /> III oth,•r then owner( <br /> FOR DEPARTMENT USE ONLY <br /> •11CAU, )It ACCrt'r[D By (� / DATE <br /> ;UR1�� i'fPlt.lf I�`UED DATE <br />