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JMis81^19V414 rsavrur <br /> `Y ......._................... (Complete in Triplicote) Permit No. ... S 3 <br /> ................_..._.............. 11h1s Permit Expires t Year From DaN lsshred Date Issued .................. <br /> dApplication is hereby made to the San Joaquin Local Health District for a permit to constnicf and Install the work hotel <br /> eigibed.This application Is made in compliance with .County Ordinance No. 549 and existing Rules and Regulations: <br /> t..'t_'ADDRESSAOCATION <br /> _...._....... ... .... ...................... CENSUS TRACT <br /> ' Otiv_."s Name ......� ........»......__»._.._....,. .._....... ..................... <br /> . _ <br /> ` `=Afddress ................................. »Pfiorro - <br /> _City .-;::x�::�.................• ...................... <br /> Contractor's Name __-__-- } ..Ucense# . .7 1rr.21. Phone .3 :: ..._ t' <br /> ... <br /> i 5lnstaflation will serve, Rosidence['Apartment House Q urt Q <br /> Commercial QTraller Co <br /> Motel Q Other.................. .�_....._.».»». <br /> dumber <br /> of living unite:............ Number of bedrooms Garbage Grinder ............ tot Size ..�1�.�?.»...---..g,.`.�..»._»».. <br /> {W ter Supply, Public System and name ................. .................... ».._................. <br /> ....Prhratb❑ <br /> Clor <br /> ader of soil to a depth of 3 fent: Sand 0 Silt 0Cloy t„J' Pea![j Sandy loan,Cl Clay Lown fl <br /> ky <br /> Hardpan H <br /> `= pa Q Adobe Q Fiil Material...­­If yes,typo <br /> fPlot plan, showing size of lot, location ofstem in relation to well: buildings,Ings, etc must be placed an reverse side. <br /> 1:tJlW INSTALLATION: (No septic tank or seepage it permitted If <br /> } p perm public :ewer is available within 200 feet,} <br /> "PACKAGE TREATMENT [ j SEPTIC TANK »_,,,,.»...... <br /> t: 1 Size.. -.-» .......,.»... <br /> . Liquid Depth ...---•------...�_ <br /> Capacity .................... Type ................... Material..............------- No. Compartments .......».........» <br /> Distance Yo nearest: Well »--�................»..»...Foundation - Line t <br /> ;TEACHING UNI: [ ] No, of Lines ........................ length of cads line....._.............»....... Total Length .................... <br /> .». • <br /> _.__...; <br /> 'D' Box ............ Type Filter Material ..:.................Depth Filter Material ..........................:. <br /> Distance to nearests Well ..:,f?xf ........... Foundation <br /> .......V.......... Property Line ...A........... <br /> SEEPAGE PIT [ j Depth Diameter ................ Number ........................ Rock Filled Yes �' <br /> -- —. 1� No <br /> F <br /> Water"Table-Dept ---------------»-------- ---»-- .»_.Rodt Size <br /> Distance toearast, Well ._......� ..».....�.W........Foundation _..2Q........... Prop. <br /> PAIR%ADDiTiON(Prov. Sanitation°'�rmit ----------»-..-......................... Date <br /> 1 Septic Tank ( uirements) ..»..».»...»..» _............»....: » <br /> Disposal Field (Spedfy Requirements) .... f.. .1 f <br /> ................................._.... _=:.:.-- •.............._ ............ # .....- <br /> {.................................... ........ .. ....- _._......_............._ _. <br /> �F (Draw existing and required addition on reverse side).... <br /> »...�. ..... »» .... <br /> ?�1`heraby�'&Mfr6at I have prepared this application and that the work will be done In accordance with Son Joaquin <br /> ;: my 04nal es, State Laws, and-�hllas and Regulations of the Son Joaquin Local Health District.Home owner or licen- <br /> 'secl agents signature certifies the following: <br /> certify that in the performance of the work for which this permit Is issued, i shall not employ any person in such manner <br /> <as to become subject to Workman's Compensation laws of California." <br /> Fa Sj fined <br /> r -. ................... .... .....................» Owner...._............. <br /> 13y .... ...- title <br /> ............ <br /> (if of than owner{ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY................ ........................................... .. DATE ....`� 6 <br /> FBUILDING PERMIT ISSUED ..... <br /> ADDITIONAL DATE=.:........... :.'_..... <br /> ... <br /> COMMENTS . �G .... ._ .�! .......................... <br /> ....................... ........_._._._.........----•---•-----._ _ .._.........._. ... ............._..... ...._. ....................---......... ........._.... <br /> ................ ............ ..... ..-...._.........................--- -----•--...-._...... <br /> ... ......................y.. ...._......_._.............._............._.. <br /> Final Inspection b .............. <br /> EN 13 <br /> I PEDc_ �. ... <br /> SAN JOAQUtN LOCAL .HEALTH DISTRICT ^/7[l, H. <br />