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1 <br /> ,s =i his-permit rxpires 7 Tear rrom_Uate IsgU(id <br />:............................................... 4 <br /> CApplication is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is ►made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> F r , <br /> _ ., .. ? <br />{ JOB ADDRESS/LOCATION .._... _ ..,�-. 1_.....4 !"7._. . ` -.._..._CENSU5 TRACT .......................... <br /> ,( � t .. ---.Phone ..............•---"..-..... ......... <br /> Owners Ndme 1 ........./.�i7`Imo. . t� r_�.................... ....... .. <br /> r <br /> Address <br /> city ... .... <br /> f y <br /> . ...... <br /> ..:.---.... <br /> Contractor's Name ..� . . ..--- - ... ....::..... License # _�- Phone ,.:.--•--.......... . . . <br /> t Installation will serve; . Residence Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other -------------------------------- <br /> Number of living units:---- <br /> Number of bedrooms _.�3___...Garbage Grinder .A/C>.--- Lot Size --�f��.r��l'�'..............: <br /> � ' �- - Nu1' , ,. .. _ - • �. t <br /> Water Supply. Public System and name ............................................................. <br /> : <br /> . .---•-- f.: ................. ---...Private' <br /> Character of soil to a depth of 3 feet: Sand j] Silt[] Cloy ❑ Peat❑ Sandy Loam ❑ Clay Loam D� <br /> Hardan ` Fi1i Material -,/rl�.._ If yes,type ------------------------- <br /> p ❑ <br /> {Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc6 must be placed on reverse side.} <br /> NEW INSTALLATION: {No septic tank or seepage pit:perriiitted if public sewer is available within 200 feet,j . <br /> ► <br /> Size. <br /> Liquid Depth .................... <br /> PACKAGE TREATMENT SEPT CTANK <br /> � -....---•---- o[ :capacity ty _. . Type ... _ ....... Materal <br /> I11 <br /> ` earet: Wel - ----•----....Foundation ,.."., _.........---._._ Prop. Line ..................... <br /> Distance t <br /> L=ACHING LINE [ ] No. of Lines`--............'•_-:----- `l:ength of eatlt line..-------...-----.:.;�:..... Total length ............................ <br /> Depth filter Material <br /> D'"Box ..__.. Type Filter Material.•..............�.... ._.--. <br /> Pro a tine <br /> Distance to nearest:Well � ' Fouriidation ....._..%k P rtY ----•••--- <br /> .,; Rock Filled- Yes No <br /> SEEPAGE PIT L l Depth r.................:.. Diameter,.:`----......:_ Number ------------..........----.. ❑ <br /> Water Table Depth ..----------•-----..............................Rock Size' ......----••-............... <br /> Distance to nearest: Well................. --?..... Foundation ....... Prop. Line -- <br /> F <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> -----------------•• --- ---.._......-•---- Date --•......:..---................... <br /> ••j <br /> ,Septic Tank (Specify Requirements) ..s---- ----- 3 -.......� S. ..... <br /> Disposal Field (Specify Requiremen# ) ........... ........... - •-- .. ...✓Y'z- <br /> t <br /> ......--- <br /> ---•------ --• --------- <br /> s ----------------------------------I......................... <br /> .............. ......._.....------. ------.............. <br /> = _.. <br /> j (Draw existing and required addition on reverse side) <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 laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licew <br /> sed agents signature certifies the following: ' <br /> "i'certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as-to-become subject to Workman's Compensation-lows of California." <br /> Sivied ----- --•....:........::.......................... Owner <br /> }: .. ------ Title.--- . <br /> By.-- i►� <br /> other than owner} ; <br /> W` rFOR DEPARTMENT USE' ONLY <br /> ' t DATE.__ .__�. '_ ................. <br /> I APPLICA ION ACCEPTED BY .. .. -: <br /> I ............... <br /> DATE <br /> BUILDING .PERMIT ISSUED �.. 4 <br /> ADDITIONALCOMMENTS ....................................... ................................... ........••---•-••--•••--•--.......•--•--........................-----..... <br /> ................-•-•-•...........................................•----. .. <br /> .............I.....--...-----..._..... <br /> iR ............................... <br /> 9 .. ........ .. ..----•-•----- ..... ...................••••----•-..Date ...... ......::_:: <br /> Final Inspection^by: ......._ _.� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />