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=� FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SA,"4ITATION PERMIT <br /> Permit No. ;7— --`3,�'- <br /> ------------------------ ---------------------- --------- (Complete in Triplicate) <br /> ' �'. - r - ``. r r� - ! ` S\ Date Issued.f l <br /> z cr - ' � - - <br /> .-- This•f ermit Expires 1 Year,From Date issued w«, •'rr,�', 4� <br /> Application is hereby made to the Son Joaquin Lo <br /> This application is made in compliance withCounty <br /> DesNo. 549 a dtrict for'arexlconstructt to work Herein described. <br /> sting Rules and Regulations:e <br /> f � <br /> -'----------- --�-. 5 TRACT ----------- t <br /> . CENSU <br /> LOCATION.- -- -- ---- -- ------------ <br /> JOB ADDRESS/ -- -- ; <br /> ° -------------- <br /> i Phone ------------- <br /> / <br /> ' <br /> - - - - ti Zip------------------------------ <br /> City - - --- ------ ------------ <br /> ll <br /> Owner's Name.--- --- <br /> PAddress _ C­ <br /> 'yLicense #-------- <br /> ----- <br /> - ----- ------ <br /> Contractors Name .- _ l - <br /> i f <br /> Installation:will,serve: Residence Apartment House.❑ ;Commercial ❑ Trailer Court ❑ t <br /> Motel ❑ <br /> I Other------------_----------- ----------------------- <br /> OF' <br /> ---------------------- <br /> G - =----Lot <br /> Sizek <br /> — z 3 <br /> __ :---- e . <br /> --Number,of,bedrooms <br /> Number of living units.-_ �/- <br /> - <br /> o <br /> ------------------ Pia -- <br /> Silt Cla i <br /> ( e-.--.- - _ --:-----. <br /> a 4 ❑ C1a Loam ❑ <br /> � Water supply:,Public System an nam Sand ❑ ❑ enal�~ Peat❑ Sandy Loam � Y <br /> i <br /> Character of soil to a depth of 3 feet: <br /> If es,. e-------- ----------`------- <br /> Hardpan ❑ c Adobe FFII Mat :Y type ` <br /> ce <br /> [Plot plan, showing size--of lot, locat on of system in relation to wells, build;ngs,'etc is avamust lab epwithon 200 feet,)n reverse de.f <br /> t <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer <br /> PACKAGE TREATMENT t ] SEPTIC TANK [ ] <br /> Size--- -- - - - - Liquid Depth -: <br /> ` '' ------Material-_-• --------------------- No. Compartments--- <br /> t + Cci'pacity-- ----- <br /> Foundation <br /> "''TYP? <br /> Foundation----------•--- -_--- -.-Prop. Line <br /> Distance, ----- r 1 <br /> to :nearest: We <br /> F 1 Length of each -- -------- ------- i <br /> ` h line.---_ Total Length.- _ .? <br /> # _ .of Lines:::--.- -: ' gr r <br /> i <br /> LEACHING LINE: . [ ] D, Box._..,._ TYPe Filter Material_ Depth Filter�Material ---------- <br /> 'D' <br /> f C <br /> - <br /> Foundation ' =----------Property Line--------------r ---------- <br /> ante to'nearest: Well----------------- - N <br /> Destt.. . ., . , k i Ye ❑ <br /> .P <br /> Number- = --- <br /> - <br /> SEEPAGE PIT [ ] P % .:--- -�----� .. .;. ...R <br /> ---------- ------ <br /> Y. . ..i .. .; Diameter._. , , �` �-.---.Rock Size.------- --�-'-- ------ <br /> . R� �•' s i <br /> s Water Table-Depth_ ------------------------------------------- <br /> Prop <br /> --------------- -----. _ <br /> i o n ... _ ine--------------------------- <br /> -- --, -- -- ----- <br /> to nearest.=Well.:-::_-- ------ F undatio <br /> k1 <br /> Prop <br /> $ ---- -"------'_:----:Date------ --------------- �'• <br /> REPAIR/ADDITION [Revu cements}n Permit#-_-_- -- - -- �� ---------------- <br /> Septic Tank (Specify q <br /> Disposal Field.{Specify Requirerne ts1 --- <br /> i - --- - --------------- ------ ------------- - ---------- -- - ------- - a <br /> T-.. . r -- ----- -------- <br /> - ------' ------------- ------ <br /> ------------- <br /> uired addition on <br /> w. i ion and that work will/be doe side) ` <br /> I herebycertify that I have prepared this-a licat' g q <br /> t (Draw exists <br /> Y <br /> PP nein accordance with -San Joaquin Count, <br /> Ordinances, State Laws, and Rules-and Regulations of <br /> the' an Joaquin Local Health District, Home owner or licensed agent <br /> signature certifies the following: ` <br /> ' a <br /> "I certify that in the perfo�man+ce of_the work for which this permit is issued, I shrill not employ any person in such manner a <br /> to become sect to Work s Compensations flaws of. California.:'. - .- --- s <br /> .. <br /> n er t�. <br /> Signed - <br /> ---- - <br /> B # _ .. ': ::.Tit e_ 't <br /> {I`f of er tlian�owner}.�. "` { <br /> .;- _ . .... _-•..�+. � �;�'• OR DEPART1111EN S <br /> fE ONLY <br /> `_ - DATE. -. <br /> ACCEPTED" BY - ' --------------- <br /> APPLICATION <br /> DIVISION OF LAND NUMBER._ --- - -. <br /> - ---.DATE--- - <br /> ♦ i E <br /> ------------------------ -------------------"-----'-_-- <br /> ADDITIONAL COMMENTS- ,. ----- -- -------- <br /> ----------- <br /> ------- <br /> � ----------------- ---- ----.__--.-_---.___-1- ___________.___-___._______.__._____ <br /> -----------------:--- ---.__---''-----`____ ____ _____________ ----.__-------------------- <br /> . <br /> -. --- ---_.-_" <br /> -- --------------- ----- _ <br /> ----- ---------------------- -Y: _ - Date <br /> Final Inspection lo �-- ---------- ------ --------- <br /> p <br /> F85 21677 REV. 7/76 <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />