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Farr&rs,.^r iwm r%ox j^vn w.^t iwiv rz:Kmi i <br /> Permit No. ..��:.�� <br /> ................................................ )Complete In Tdptletrte) I <br /> Date.hsuad 1-tv <br /> ate Issued .ti✓—Y.(4.J4__ Thh Permit Expires ti `feaa IFroerr ��'ipltcation is hereby mode to the San Joaquin Local Health district for a permit to Conct and e � herein <br /> ff scxibad This applkatit i nrada !n rem tlan� with sq Ordinance Na 59 a of Ru�tex �l�tf3onsr' <br /> 'ry <br /> CENSUS TRACT .......................... <br /> J08 AC3DRESSAOCATION . . .... .. .......... ... ,...... <br /> ia .�� . � .. ..Phone .................................... <br /> Owner's N6En7@ .... ... .a..«._». .,........ . <br /> Address .:... :?� f - �6 .................. ............................ ............»........ <br /> .... . ..» <br /> Contractor's Name ,G ` s - .......... ..................»._--_.....Uaenss# �c� ", ._.�, Phone •-= i�" <br /> ( ---------- .... <br /> Installation will serve: Q Apa rftnem kjamse C] Commarcia!oTrallsr Court Q <br /> Motel Q Other_... . ...-- . .�._....�....... <br /> Number of living units:....-------- Number of bedrooms ...-...._».Garbage Grinder .._ ........ Lot Stu ...... ------- -------------------»-.-.,, <br /> Woter ...........SuPPIIft Public Sstem and name -...__...._...�_.�......___.. ,..__._._._........................_....�......K_t'rlvate Q <br /> Sy <br /> stern <br /> I, 0 clay to"❑ <br /> Character of soil to a depth of 3 festr Sand 13 Silt CI y Q . Peat-E3 � Sarrdt► "= <br /> Hordpan'Q Adobe❑ Fill Material............If yes,type............... ........... <br /> Ui <br /> (Plot pian, shaving size of tat, loaastion of systerrr M relation to well s< buildings, etc. must be placed onreverse sides) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sever is available within 200 feet,) <br /> PACKAGE TREATMENT f j SEPTIC TANK�{�), Size.............-__..,......................... Liquid Depth ----........-............. <br /> ,� f .. <br /> Capacity . • TTpe _ Mateiot.. .........--..... No. Compartments ,.�........... � <br /> Distance to nearest: WA. ....................... ...........Foundation..__............. .... Prop. Line, <br /> -- ... <br /> LEACHING LINE [ No. of Lines -- ---------------- Length .. <br /> th of each fine-.�� /..----....... Tota Length .�� �............. <br /> 'D' Box _--j-..... Type Filter Material Act-- -------_Depth Fiber Material ...Ae...........»--............. <br /> Distance to nearest: Well ......................... Foundation ......._ ............... Propsrty line ........................ <br /> SEEPAGE PIT [ Depth --..._........-..-_. Diameter ---...... Nmber ......................... Back Filled Yep Q No <br /> Water Table Depth .............. ---»------------Rock Stu .................................. <br /> Distance to nearest:Well ---------------------------.----------Found00 ........... . Prop. UN ........_...._....... . <br /> REPAIRIADDITIQN(PMV. 5anitation Permit#- --- .---------------------------- Bate ...-.-..................._._ <br /> Septic Tank (Specify Requirements) ........................................ ......................................_..................._........,......-.............. <br /> .. <br /> Disposal f=ield (Specify Requirements) _._..»..............._._..._ _.....................-.......-----....-.._......................................... <br /> ............. ........................_..........._.-._........_.----...........--.......... .......................................................... ..........•........................... <br /> . <br /> __........._-•- . ---....................................�t]rauvexistirrg crud required addition orr reverse side). .. » <br /> ...._....,.-•---._. .......,.,...._..... ............ <br /> t hereby certify that I have prepared this application and that tie work will be done In accardanee yids Sao JwMuls <br /> County Ordinances, State Laws, and Rules and Regu atlens of the San Joaquin Local. Health District.Ifsme M"Or er Ileen- <br /> sed a oats signature certifies the fatlawing: <br /> 9 B <br /> "I certify that in tho performance of the work for which this penult Is isseed, I drat! not employ ants person In suds Ma <br /> nner <br /> as to become sub eet to Workman** Compensatlon laves of California." <br /> Signed .... � ........--•------------...... Owner <br /> By ........ ------- ----- ............................:... itfe ...----- --.._... ......... ..._......................... <br /> {if other than owner <br /> R DEPARTMSHT USE MY . <br /> APPLICATION ACCEPTED BY.--- .. _. .................. ....... IDAI �- �:�.. -......_.... <br /> _.. . <br /> BUILDING PERMIT ISSUED -------------------- ----------------- ............_............---...------ ------ ......1)AtE ..... �... <br /> I DD#TIONAI COAI1Mi:NTS ..... ................. ...:.... .... ............................... <br /> ........................—.1-.......-------------.................... ..................................... <br /> {fin--a'f Inspection.........by, .... ` . . ............ .... ?"-'`--EH 13 2h 1.-68 Rev. 514 SAN JOAQUIN LOCAL HEALTH DISTRICT 8f71i 3M <br />