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'= <br /> FOR ��U ��� ��������� ���N�� <br /> ����n�**xn ����� <br /> =~^ `'~'- - (Complete lnTriplicate) <br /> This | Expires 1 Year FDote |uyvmd��mwUmww�� <br /> --------------------------------------------------------- <br />---r App)ioot|on is h- -/ mo6eroYha Son Joaquin Local Health District for o permit to conntruct. and install the work herein <br /> n <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> Contractor's Name <br /> Installation will serve: v Residence'[] Apartment House <br /> [bmme�o{��i��� C] <br /> Motel []O+her 2 <br /> / Lot Size <br /> Vvotor Supply.- pob//c System and name -. 1 _-'^"^- ^=~~....-_--'--------------- <br /> Chor��erofsoil toodepth of3feet; Sond[� ��||t0 Clay E] 'Peat E] Sandy Loom Clay Loam El <br /> Hardpan [] Ado6"~�Y Fill kAawor|o| ----------- |fyes,type -_---_---- <br /> NEW INSTALLATION: k or seepage pit permitted if public sewer is available within 200 hmst)A. <br /> PACKAGE TREATMENT [ ] SEPTIC TANK uid Depth ` <br /> � <br /> Capacity ��u�.u��/.�� `yp��^^x�^~��*` - Material~--~~`^~--' No. <br /> ,--mp-' - <br /> / <br /> D|stonoe to nearest: Well X&Le --------------Foundation ------------ Prop. Line -'���-''--- <br /> h-no�6 x ^ <br /> -_ Toto '~' --------------- <br /> LEACHING <br /> UNE No. of Linea .----/—.--- Length u' -------- <br /> 'D' Box -'-- Type Filter Material .6� Ker ----- <br /> . <br /> pth Nkx���| -'-��.��------�-'- <br /> (c -~ <br /> Distance neomm` VVeU`�� <br /> .......- � Fou / ion ---/_0 <br /> .~.7---/ Property Line <br /> I - , - . Rock Filled Yes - <br /> _N-u,0 <br /> SEEPAGE PIT Depth �,—.- D�omet�, - ?- ^- <br /> .- <br /> Voter Tob|e .Depth - -----------------------------------Rock Size <br /> -- -- - -- - <br /> / ^ <br />' m` VVe | Foundoh�� ^'�) prop Lh�a <br />' CUsoncetoneona / -�~^^�����°�.---.--_' �",..-~-_.- - . <br /> �o�e -------_------- <br /> Septic <br /> _ � <br /> (pnn'. Sanitation Pormit�� ------'—'-�----' '--------'-'--' \ <br /> ` ~ <br />� OepticTonk (Specify Requirements) -------------------------------------------------------r.'.-----------------------------_------------------ -__-_.-_-'- <br />| Diopo,o| Field (Specify Requirements) -_--'.-----'--------'�-----'---------------'------- <br />. ' -_�-��--'-_—'---`--_'_''-----_---'_'_-. <br />| ---- �---------------------'---' ^ <br /> � _-'_-__---_'---___-'--_' <br />. ^ —_------�---_'--.-'--_-_.--'--- <br /> ----' �'-'------'— 6 ina6 �66OH onrevenmvk�e <br /> (D,ovvexis�nQon required on ""�� <br />� | hereby certify that | have prepared this ' ' ��m�mn and that the work will be done in accordance with San Joaquin_ <br /> County �n�n�mm'^�wx«e L���, m�� ��Y�y � ����ywGmmm �f �hm $mw ���qmi� L�«�| Health D;mm�«o' Hommeowner or limen- <br /> ^� <br />\ <br /> sed agents signature certifies the following: <br />� ^'V ify that | N, �� f thework for which this permit is issued, l ohmY| not employ any person in such manner <br /> as to be <br /> bCalifornia." <br /> / Owner <br /> Signed -' <br /> � , r <br /> By -----'-'' --- Title" '������ '' <br /> ----'-' <br /> (Ifother than <br /> owner)I FOR DEPARTMENT <br /> � - USE ONLY <br /> '^ <br /> / xrruC*//um AC I CunED B, `, ---------------vp ------------------------------------------------------ <br /> � ------------------------- <br /> BUILDING,PERMIT <br /> -------------------- <br /> � *um/ <br /> Final Inspection by: Date <br /> ` ' J«^�n|N LOCAL HEALTH DISTRICT <br /> ~ <br /> SAN �"�° ~. � <br /> \ , <br /> � �\ E. H. 9 1''88 Rev. 5M <br />