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a=ar"r~t.s s raaa.r r"bref �a�a r!�a rm,�a-s a�r:aa%u a <br /> ............................... Permit No. ..�.-J.Z. <br /> (Complete in Triplicate) .21 <br /> fi&q- <br /> t <br /> sued - ~. <br /> i This Pierinit Expiras i Year From tote Issued <br /> oitcalsora !a taasetay made to Iho Son Joaquin iacal Health L]lSfTltfar a permit to construct ani work herein <br /> cribed. This application Is made in scam liaana:e with Co my Ordinance No. 549 and exi tinRulesVgutatlonsa <br /> JOB ADDRESS/tOCATIO� lh-+ 4'`............. ..................CENSUS TRACE ...-...-...-_............. <br /> - .-. <br /> �r 2-s.5 - 0=-t Phone <br /> OwnersNorse .��.`�:.. - -• -...- ._.. ...................�-.-_....,....._.---._.::,............:•---.....-.......-....... ...........----....... _........-.._ <br /> Address .... .-.._, /r2 d l &` _` ., ` ' ----------------City <br /> Contractor's Name ....- :.� �... ---------- ---------•- <br /> License . :: . Phone <br /> installation will serve= Idence❑Apartment so 0 Commercial oTraller Court 0 <br /> Motel[)tither -.a. <br /> Number of living units:--------.... Number of bedrooms ..._..__--__Garbage Grinder ..._____._ Lot Size ____..__---------------- --------------- <br /> Water Supply: Public System and narne ..---------•----------••----____...---------------------...-......,---------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Slit® Clay ❑ Peat 0 Sandy Loam 0 Clay Loam ❑ <br /> Hardpan 0 Adobe 0 Fill Material ............ If yes.type --------------- ----- ------ n <br /> !Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) UA <br /> NEW INSTALLATIONz (No septic tank or seepage pit permitted if publlc sewer is available within 200 feet,) � <br /> PACKAGE TREATMENT SEPTIC'TANK; I Size_---------------................- Liquid Depth .......................... <br /> 1 'n�T <br /> Capacity ype _- iV►atericsl...................... Na. Compartments .......-.,,. <br /> Distance to nearest= Well ____________________________________Foundation ...................... Prop. Line .............. <br /> LEACHING LINE No. of Limes .. Length of each line-J .r-_.._..- -- Total Length .................. <br /> .Deth Filter Material _-_ °�'�.�................ <br /> 'D' Box -J......_ Type Filter Material -- ., p •------._.. <br /> d <br /> Distance to nearest: Well ........................ Foundation ..........____.... Property Une ............. <br /> -SEEPAGE PIT Depth ---------------___- Diameter ---------....... Number ----.-- ................... Rock Filled Yes ❑ No (np <br /> Water Table Depth --------. --•--------•---.....---Rock Size ................................ <br /> c4 -- Foundation -------- Prop. Line ..__..._.-----__ <br /> Distance to nearest= 1lVel1 - ---- --------------------------------- .__..-----•- ----------- <br /> REPAIR/ADDITION Wray. Sanitation Permit` ___------.............................. Date -----.----------.........,--------) <br /> Septic Tank (Specify Requirements) .................................,................. ..--••---a----........-.,.... _------._..--..._..---........._...._..__.-,......... <br /> Disposal Field (Specify Requirements) ... ....... ••---------- -------•-..... ---•------_-_-• --•--------•-------- - <br /> ....I......... ---------------- ---------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that ttae *work will be done In accordance with San Joaquin <br /> County Ordinances, Stare Lanus, and Rules and Regulations of the Scan Joaquin Local Health District. MOMS owner or Ilacen- <br /> sed agents signature certifies the following: <br /> •'i 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 icaws Of Cati4ornia°• <br /> Sinned ..... � ............... Owner <br /> Y <br /> -�A <br /> ........... i'itle . . ...... .. ... -.. .- ---- <br /> Of other than owner) <br /> IF >T DEPARTMENT USE ONLY <br /> �4APPLICATION ACCEPTED BY . _ ......... DATE <br /> DAT: -. -_... ----- .........UILDING PERMIT ISSUED .... <br /> DDITIONALCOMMENTS .. . . <br /> - <br /> -... <br /> COMMENTS .. . . ...... . .. ..................... <br /> ,...- -- <br /> r <br /> Final Inspection by. -.. .- -.. . ...__' .....Date . .... ..- <br /> ,Ii 1.3 2h 3--6f3 &V. ! SAN JOAQUIN LOCAL HEALTH DISTRICT 6/74 3M <br />