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4ROFFICE UA: . . . _ <br /> Aaai ICATIoa FOR SANITA1 ' 5 3 o .5 <br /> (Lo(q ,,(Complete in TripN�ah►l <br /> Permit No. 7 zg <br /> _.... _ <br /> J O This Permit Ex Tres 7 Year from <br /> f su d Date issued . .. ..:.7 <br /> : ........ Doh Issued <br /> Application is hereby mode,to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application.ltmade in compliance with County Ordinance'No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCAT jPN <br /> d ...._. ��. .............. ........... ..,....CENSUS TRACT .......................... <br /> Owner's Name ... ........... .. ..:..... .... ..............Phone <br /> Address -fi=g.>. �i. '�`d.. ... ......... ............City .1 . ........................................................... <br /> Contractor's Name- � f ly-- tirir __.15-`l�►v�C-t............ ................License jtJ 'c74 Q..... Phone <br /> Installation will serve: Residence Apartment House 0 Commerclal,oTrailer Court 0 <br /> Motel[]Other......... ............................ <br /> Number of living units:-2..... Number of bedrooms ...,(.....Garbage Grinder ..0.040. Lot Size <br /> Water Supply: Public System and name ........................................................r....................................................Private, <br /> Character of soil to a depth of 3 feet: SondA Silt Q Clay ❑ Peat 0 Sandy',.Loam Clay Loam <br /> Hardpan Q Adobe.❑ Fill Material............ if yea,type............... ............ <br /> (Plot plan, showing 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 permitted If public sewer is available within 200 feet,► <br /> PACKAGE TREATMENT. ] . SEPTIC TANK{ ] Size......................._._..... ......_........ Liquid Depth .......................... <br /> Capacity ./,�.©_CU.. Type RA:f!,t t5/'Mated0Idt0N. -No Compartments ............ <br /> Distance to nearest: Well ...1.x..0...... ........Foundation --- - ..._...... Prop. Line ...`^....__.._...... <br /> LEACHING LINE [ ] No:, of Lines ........................ Length of each line.............................. Total Length ............................ <br /> ,D' Box .........-.. Type Filter Material ...........:........Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ....... .............. Property Line ........................ <br /> SEEPAGE PIT f I epth .................... Diameter ................ Number ...................... Rock Filled Yes (3 No [j <br /> Water Table Depth ._._ ..._.t.....................................Rock Size....... ......................... <br /> Distrtrlus to newest: Well ........Foundation <br /> • � -•------------------------ ....................... Prop. Line ...................... <br /> • <br /> REPAIR/ADDITION(Prey.Sanitation Permit Date .................................. <br /> Septic Tank (Spectly Requirements) ............ y. ................................... ..... .... .............................. <br /> Disposal Field )Specify equirements) .�litir'...aAL. .......... <br /> oz..--------- O v� '. ------•... ...... -. ....... . _ ................................. <br /> ------------------------ ---------- ................... ---- ' x l <br /> - • . �Vors�e <br /> • • ----(Draw existing a61� required a itiononide) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State taws, and Rules and Regulations of the San Joaquip local. health District. Horne owner or fit** <br /> sed agents signature certif s Ilse following: <br /> "I certify that In the performance of the work for which this permit is issued, 1 shall nyt employ any person M such mann <br /> as to`become subject to Workman's Compensation laws of California." - ' <br /> Signed . . . ........ <br /> .. . ....... Own <br /> er <br /> BY 3itl <br /> ----...... ................... <br /> (if <br /> w <br /> other than owner) <br /> FOR EP"ARTMEN;9 USE ONLY , <br /> APPLICATION ACCEPTED BY .,_-... _.. .......... .. ... ... ...--.- .............. DATE DATE .� -:�-� ,--•--......_.. <br /> BUILDINGPERMIT ISSUED .................. ......... ......•--•-.....------........- -- -----------.. ...-----.-.....DATE ................................. <br /> ADDITIONALCOMMENTS -..♦..._.. --•- . ----•--•••--•••-•.......••-• ................_....--------._..........----......................... <br /> •--• ................................ <br /> - ........ 7 ...... .. <br /> Final Inspection by. .. ..... ------- .:....Date .... . �f <br /> Z.,j ............ <br /> Of 13 2h 1-68 ��• � SAN. JOAQUlN LOCAL HEALTH DISTRICT 6/7l� 3M <br />