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FOR OFFICE USE: <br /> . . <br /> Date Issued <br /> Application is h ,othe San Joaquin Local Health District for aper,mit to construct and install the vhereinrk herein � <br /> deacHbe6. This application ismade incompliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ^ , <br /> ]OB'ADDRESS/KOCAT|ON --------�----------- 5,,-.2--------------------- TRACT -------------------------- <br /> - <br /> ' <br /> #KContiactor'4 Name . --------License# Phone� <br /> Installation will oewe. Residence ZApartment Hoveo-E] Commendo| :F-lT,o/|erCourt 0 ' - -- -- <br /> Motel F-1Other ------.---.-_.---' � <br /> mu be�of living un|to`' /—.. Number of bedrooms l/ .- z<�/�- � � _- <br /> 'Go6��ga �k|n6o, Lot �� `-��. ' � <br /> - ! <br /> Water Svpp|y, Public System and name —'_---_-----'—__—.--__—'___.—___---_Privote�� ` <br /> Character*fsoil *nu^depth of3feet: ' Dand'E] Silt El Clay E] PeatE-] Sandy Loam Clay,Loam E] <br /> Hardpan E] Adobe�� Fill Material ------------ |fyen' type --------'-- <br /> (Phot plan, showing size of �t location of system in relation to wells, 6vi|6|n0,' e�. mvo+ be placed on reverse side.)` .^ <br /> NEW INSTALLATION: (No septic tank or seepage p|tpe,mi�e6 if public sewer is available within 200 feet) <br />_ � ^ ^^ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-------------------------- --------- ------- Liquid Depth -------------------_.- �1 <br /> ^ ~ <br /> Capacity -`------- ---- ---- Type ------------- ------ Material ---- -- --------- No. -------------- �� <br /> � , <br /> Distance to nearest. VVe [ ------------------------------------Foundation ---_'--' Prop. Line -'_'_.�'''_ <br /> . .�^ <br /> i5A�H|NG; L|NE [ ] No. of Lines ---- ------------------- Length of each Una--------------- Total Length _—'—'—'—'—'-- <br /> ^ <br /> Water Table Depth <br /> --------------------------------------------------------------------- <br /> Disposal Field (Specify Requirements) --- ...... -eelllf-1 —---- --. <br /> (Draw existing and'required addition on reverse side) <br /> I hereby certify that I have prepaied this application.,and that the work.will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, cir�d Rules' and Regull�tions of the Son Joaquin Lo'cal Health Disteict. Home owner or licen <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of th-e work for which this permit is isivad, Vshall not,employ any porson in such manner <br /> as to become/subet to W k an's .-__inpensation lawt'of California.", <br /> (If other than own'er) <br /> FOR DEPARTMENT USE ONLY <br /> ------------------------------------------------------------------ <br /> JCAQUIN LOCAL HEALTH DISTRICT <br /> Final Inspection by; <br />- <br />