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L__ <br /> ICE USE: ` gPP,t41CAT101+1 FOR_SANITATION PERMIT <br /> Permit No. -1`----°�--7 `-- <br /> ---- -"-" (Complete in Triplicate) rDate issued/-0~�/`7D <br /> --- '-------- PThis Permit Ex fres 1 Year From Date ssue-------- --- } <br /> Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the work herein <br /> described. This application is made inrc mpllance with,Count Ordinance No. 549 and existing Rules and Regulations: <br /> /S <br /> �,� '�t�►...T.:-� �� - �,.._.-� x rte-- ----- ' - ' '---CENSUS TRACT _-= --------------------- <br /> . , . <br /> R1 SS/L GA+T10N <br /> JOB ADD _-- <br /> • Q h.r �. .t17---®® -----t-�--------�----------- .---- ------ -----� ----' --'--- '---Phone ---------------------•------------•- <br /> Owner's Name ----- --- - Cr I^ <br /> �* 't° r City-/ --------------------------- <br /> --- ne / .. <br /> Address - ,,,�.C1..a` - '---- --�[j�Cr'_G_ =�k� ! � � �'�. Ph <br /> A,•�•--- --_.Li+cense #� - - <br /> Contractor's Name -- -- <br /> Installation will serve: Residence'o Apartment House 0 Commercial Trailer Court i❑ <br /> I i _ __ <br /> Mote! ❑ Other .-.--.�---- <br /> ss�� i f _-.-- arba e Grinders-- Lot Size -- ` <br />` Number of living units:--- Number of bedrooms --- g _Private ffi <br /> Water Supply: Public System and name --_.-----_ fl ClayLoam F-1Silt Cla ❑ Peat❑ Sandy Loam �-[I <br /> Character of soil to a depth of 3 feet: Sand'[] v <br /> Hardpan E] Adobe Fil! Material - ----- If Yes, type ---------------- - - -- <br /> t laced on reverse slde.) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be p \ <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted,..lf _ublic`e ✓er is available within 200 feet,) <br /> " Q ;� Sizer-i�� - Li iuid De th <br /> +� q P <br /> PACKAGE TREATMENT [ ]' SEPTIC TANK:[)4 r ------ <br /> ` � No. Compartments -- -------------• <br /> : Material b ... <br /> Capacity Type <br /> ;t----------------- -/-fes-.f Prop. Line _ <br /> Distance to nearest: Well -------- -- ,, i <br /> Length f ach line . ��----- ------ Total Length _40-a--------------- <br /> LEACHING LINE <br /> [ No. of Lines ---QRZ---------- moi' <br /> Type Filter Material k�R� Depth Fil#er Material ------- o <br /> I D' Box J--- YP 1� <br /> -� Property Line. --A9-------------• <br /> � --- --- . Foundation - ---" ------ P tY - <br /> Distance to nearest: Well .---9----- <br /> ��p- -- Number ---:�-------------------- Rock Filled Yes ' No � <br /> ` SEEPPAAG-E FIT � Depth ----------------- Diameter - !� ,;_ t .. <br /> Rock,Size �. .-^-. ---------------- <br /> 0 <br /> ----- ------ <br /> E Water Table Depth�..-_---- -s�„--=--°=_--,�,----- �-------• � <br /> ! 3 Foundation .' - -'--- Prop. tine .. ----•- , <br /> Distance to nearest: Well .---- -- ��� --”---- <br /> s Date ------ i-------------------) <br /> REPAIR/ADDITION(Prev. Sanitation Per mit# -•------ ------------- .�-.----- ------------------- <br /> - -------- <br /> Septic Tank (Specify Requirements ._------------- - - - <br /> Disposal Feld (Specify Requirements) - ------------------------ <br /> --------------------------------------- <br /> i <br /> --------------------------- <br /> .................. <br /> - ------------------"------ ..--,..--..__�.-_..__..__.-_.. _..-.--_. --- ----__.. <br /> (Draw existing and require a ddition on reverse s" e <br /> I I hereby certify that I have prepared this application and that the;work will be done in accordance with San Joaquin <br /> unt Ordinances, State Laws, and ules and Regulations of the. San Joaquin Local #Health District. Home owner or licen- <br /> Co y <br /> i t. <br /> sed agents signature certifies the following: person in such manner <br /> "I certify that in the per <br /> forqmance of the work for which this permit is issued, I shall not employany <br /> as to become subject to wt rkmon's Cjmpensotion laws of California." i <br /> t Owner <br /> --- <br /> ---- ------ 1�,1 € _ r... <br /> Signed - -------------- <br /> • -.o. Title � -''--------- <br /> - ------------------------- <br /> (!f oth an owner) <br /> r F EPARTMENT USE ONLYDATE 1.6 --�- <br /> 0 /-- ryq_ ------ <br /> i APPLICATION ACCEPTED BY ------ -- - --- DATE _------'----'---- <br /> SU4LaING PERMIT ISSUED ----- -- <br /> - - <br /> ADQI�`10N�L COMM 7 - --------------------------------- ----- - ------ ----- -------------- ------- -- -- ------- ---- ------.-� '---' <br /> ------------ - <br /> ----------------- <br /> ----- <br /> --- ------------------- <br /> t -Date - --6 <br /> Fin�k Inspection b - -------------------------------------------- <br /> 11 <br /> ------ """--""-------- <br /> - - - ------- - - <br /> 1 N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M\a <br /> .,t,�`t�..�1 C3�' j'� ``� "` �..,-..,, �..' rte• � <br />