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` ....................................... AMMATION FOR SAWAMNJ`PIERMIT d <br /> fCerNdete rm Trlpntatl PrtnmlM rla. �..- �` . <br /> . ................................ <br /> This Kermit E,plrss} Yea►frons Dab Inver Do" <br /> '4 Application is hereby mode to the San Joaquin Local Health District for a permit to sonstrvct and Install lite'work Woo <br /> dosuibed. This applieotton Ismodo In compliance with County Ord rue No. 519 and existing Rules and R�putofiorge <br /> ;:.•'s:`4 JOb ADDRESS/L {,l ...... s r: <br /> �.............................CHJSLU_S-_,��/K.yy/�..�'�333 .........«.«......• . . <br /> �'F •�- N t i •.....«_.........................r.....•........• .. •...1"FRi�1Q.�{f.r(�.�......• °� <br /> Addns:SQ�tJ :., A.�'! •9... <br /> ................ ........... City. c. � .r................_ ii <br /> �T........................Llarnse,l3:,�1.�i 4.... Phan.�;S� ifs . <br /> 1' r, <br /> ' instaii0jon will 4wv4h Residence❑ApNkrAb tt Hovt4 Camnwrdaf OTroller Court Q <br /> Motel C3 Other A <br /> Number of fivlrg tmitar...I....•. Nm6w of bedrooms ....I. Garboge Grinder ............ Lot Size <br /> -. - <br /> Water Supple public Systern and name ..............�....»...........................�»..... I <br /> dtarawr of soil to a depth of 3 feet: Sand❑ Silt p day Q Peat❑ Sandy Loom Q Clay 160 j <br /> HwdPas❑ Adobe Q Fill m6teda!............If ys,;,type»..,..».»... } <br /> k iPloe pkw, showing sire cr lot, location of system lr s'•,a• ,welis, buildings, etc, wwd be placed an rwww'd&J <br /> NEW INSTALLATION: � <br /> feN " <br /> lNo septic tank or ssePoge`pit Permittee: Ifpublic sewer Is avoiloWe wHhMs 701) ,I �� . <br /> PACKAGE TREATMENT SEPTIC TANK C] Sue....,4:,&........... ........_... Liquid Depth <br /> copodtY.r✓,a V..... Type C Mah:;af.�c} � Flo. Com meets....._..__.._ <br /> Distance t `' � • . � � <br /> ors.ansh.Well ..:....................F� <br /> lEACFi1Nr+LINE {�No. of Lines ............. Length of nadt itrte .........» Total Length <br /> •D' Box .f..... Type filter Matsrtal�.&zl .Depth FINw Material <br /> ' .�� 'p >1 <br /> Distance to nearests Wall Foundation .l Q. Prop" Line <br /> �i <br /> SEEPAGE hirh+r � •��. ............. ..+ ....::..:ar : <br /> r k}'� Depen ........ Dlamotw ... ........ Number ....xr. ..... Filled} Y <br /> Water Table Dopes ............ .................Rock Sise.�...x..Xa�.� <br /> Distance to nearesh Well .../C ; .......................FouadatlanNod......... Prop. LIrN` . <br /> ' ItEP&2/AD1)MM JProv.Sanitation Permit f..._....................................... Dote .........._........ r `i <br /> 1? Septic Tank (Specify Requirements) ........................ ............ _.............................»...r~.....�............_.�......._....». <br /> Disposal Field (Specify Requirements! ..............:. «......................................»................ <br /> _.......................__.......:......:.«........ <br /> s` ' .........................I......................»........................................................................ <br /> ......................._._..:..... <br /> :r �Drow existing and regvked addition on rewww mei <br /> .......»...............................».«.........._ <br /> 1 hereby certify that I have prepared this application and that Hee work will be deme In twerdensre vJ110 :eve 4101111191111 <br /> County Ordinances, State Laws. and Rules and Regulations of the.San Jeetgtrie local He" DisMd.Hama women W par► <br /> sed agents stgnatw'e unifies the following: <br /> "I certify that In the Wormanca of the wor',c for which this permit is issued, I shop not employ coy perK" In strccls twstrrlrer 1 <br /> as to become subia to Workman's Co a ation laws of Callfernia.- <br /> �' _ Signed........ .............. tJwner <br /> By.... '�--"Y---. .. ..... ............................. Title................................................................. i <br /> if other than o ti <br /> FOR DEPARTMENT USE ONLY <br /> *"' APPLICATION ACCEPTED BY DATE 3 ��� ' <br /> ..... .................. <br /> BUILDING PERMIT ISSUED.................................................................. ........... DATE <br /> ADDITIONAL COMMENTS ....... ........... ............. _ _.... .... ............................ .......... .... <br /> .-............................. s <br /> i ................ ... ........ .-a.................. :; .. '... ............. ........ ............................ ........'...,,...;t...:...................... .... <br /> t ,. ................. ..... . .............. ...... ... .... ... E-...... <br /> Final Inspection by: l // 7 <br /> i la.:f'J..��...4 ' ......................... ...............................Date.. .L �� . ........... .... <br /> i ,Fit 13 2h 1-(jn Hav'j1�t SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> � �/7L 3i'f <br />