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FOR OFFICE USE: -------------- <br /> APPLICkTION FCIf�,SAN TATION PERMIT Permit No: lQ <br /> `(Complete iri Triplicate) <br /> ----------I---------------------------------------------- Date Issued <br /> ----------------- ------------------------------------ z7,:-­T9j­1; Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per'mit 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 /> JOB ADDRESS/LOCATION --r---------- - A. <br /> A 0-_ir_ A -------------CENSUS TRACT -------------- ----------- <br /> 4�1 J, -Phone <br /> ------------ 001/------------------------ --------------------------- <br /> Owner's Name -------- <br /> Address --------------------- ------ City --------J--.76,_e <br /> z�, <br /> - 0�,Om--------------------------------------- <br /> Contractor's Name ------------------- 0-ffl$-—------------------------------------------License # -------- ------ Phone ------------------------------ <br /> Installation will serve. Re 1 s I Idence partment House,E] Commerciol :oTrailer Court <br /> Motel ❑Other --------------------------------------------- <br /> Number of living units:----/,�Number of bedrooms _42—Garbage Grinder ------------ Lot Size _e';--_xxp�-------- <br /> Water Supply, Public System and name ---------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet:.; Sand'] Silt❑ Clay E-] Peat El Sandy Loam 0 Clay Loam 0 <br /> Hardpan F-l Adobe F1 Fill Material ------------ If yes,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 g/PJ1-- S0EPTlC TANK![ ] Size-------------------------------------------------- Liquid Depth ---------------- ------- <br /> Capacity - Type i?-C-A----I Material No. 10 Compartments ------ <br /> Distance tol nearest: Well ----------- -----------------Foundation .7-11 7-----------.Prop. Line -----J�--------- <br /> LEACHING LINE No. of Line's --)—------------- Length of each line------1&0 ------ Total Length __,14V--------I------- <br /> 'D' Box --- Type Filter Material_ ppth Filter Material ------A-91--l",------------ ............ <br /> 57771 UP-bit) <br /> Distance to nearest: Well ------------- Foundation __74------------- Property Line -------- <br /> SEEPAGE PIT Depth -- <br /> --- -------- Diamete fA�'J�;o Number ------ Rock Filled Ye. s'UJ,- No .[3 <br /> 00, <br /> Depth e <br /> Water Table ..........60-------------------------------Rock Size ---------------------- -- <br /> f <br /> Distance to nearest: Well ____Li-r?,- f --------•-.-Foundation 64.rov,--------- Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit+ ------- ------------------------------------ Date ----------------------------------} <br /> SepticTank (Specify Requirement;) -------------------------------------------------------------L--------------------- ----------------------------------------------------- -•- <br /> Disposal Field (Specify Requirements) - ---------------------------------------------- <br /> - ---------------L-------------=------------------------------------------------------ <br /> -------------------------------------------- -------------------------------------------------------------------------------*----------------------------- -------------------------------- <br /> '40- 1 <br /> -------------- ---------------------- ----------------------------------------------------------------------ml------------------------------------- <br /> ------------------------------------------------------ <br /> °(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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San'Joaquin Local Hea-ith District. Home owner at licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I sF;aII not employ any person in such manner <br /> as to bec9m 1griman's 4 jCi�mpensatiqn a <br /> .0 subject to t' laws of California." <br /> Signed __ApUrb-—-------------------------------- Owner <br /> By ------------------------------------------------------------------------------------------------------- Title ------------------------------ --------------- -------------------------- <br /> Of other than owner) <br /> Zla4�EPARTMEN SE ONLY <br /> APPLICATION ACCEPTED BY ------ ---------r----------- -1-1------------------------------------------ -DATE <br /> PERMITISSUED -- --- ------ - ------------------------------------- ------ - DATE -------------------------------------- <br /> BUILDING ADDITIONAL COM4ENTS 01 ----I <br /> ------------------- <br /> -1-- ------ ---- <br /> / <br /> - - ---- _V - - /-- <br /> f, <br /> _7--- -----------J--------------- <br /> ---- <br /> Final InspXionby: ---- ---- ----- -- --------------------------------------- - te <br /> OAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. <br />