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•----?GP OFFICE USL: l.ICAea,v,., <br /> t-UK J <br /> •----' tCmplete i <br /> I n Triplicate) <br /> •T N <br /> f <br /> ` Year From Date Issued <br /> Thiis Permit Expires 1 <br /> f ' <br /> i <br /> + Quo <br /> made to the San Joaquin Locnl Healfih District for a permit to cc dTnstal- he work herejg <br /> in <br /> t Application is hereby Ordinance No. 549 and existing'Rules Arid RegulattoFs 4 e <br /> descrEbed...This' application is made in ;ompliance with County <br /> CANS`US TRACT <br /> r <br /> � <br /> -,. <br /> €t <br /> I. JOB ADDRESS/LOCATIONone <br /> rJ �L , /7.. <br /> owne�,s''Name1r', --J,�`` � <br /> r <br /> 16 <br /> r------ ----- -- ' <br /> f dress .. �U. <br /> r-_ <br /> Ad - f1 License # r <br /> Phone <br /> ---------- <br /> Contractor's C t ❑ <br /> Named <br /> rCommercial ❑Trailer our , <br /> Residence Tpartment House <br /> t x:'Installation will serve .<, ,. <br /> aMotel ❑ Other . ----- - " V <br /> Lot Size <br /> 7Gu <br /> Number of living units: Number of bedrooms --- --•-Garbage Grinder ..-_ -.... <br /> .........Private [� - <br /> p Public System. and name ------- ---- -- -- <br /> . ' ' <br /> Water Supply, Y Peat ❑ Sandy Loam Clay Loam ❑ <br /> Character of soil to a depth of 3 feet: Sand Silt play Material if yes, type <br /> Hardpan r} Adobe _ Fil '. <br /> _I - -- <br /> it <br /> - y is va'I ble within 200 feet,,/ t <br /> {Plot plan, showing size of lot, location of system in relation to wells, building„ etc. must be placed on never side.) <br /> NEW INSTALLATION: I� iNo septic tank or seepage pit permitted if public sewer �r <br /> ..'� � ' �. '� h . '---' - Liquid Depth ----" --....:.L..... <br /> Size.--' ..: <br /> PACKAGE TREATMENT;, [ SEPTIC TANK [ J ,�. i, ,�;,�/L". T�U" ... <br /> capacity /-� U�9�Type --------------------- <br /> -:5Material-----"-----' Na Compartments <br /> :l j.. . . <br /> l c 1Pro Line . -_----1`� <br /> r Foundation ... -- p. , <br /> Distance to nearest: Well ..-------- <br /> ' <br /> . <br /> Length <br /> Total <br /> eac ' '- . ...Leng <br /> Length /y11 <br /> LEACHING LINE ;i No. of Lines -._..... ' I' <br /> _De Depth Filter Material --- ---------- -- ----' <br /> D' Box .__: Type Filter Material ----------- p <br /> �U..--.. ---- Property Line _.__�.4�-�._..--_ <br /> �< Distance to nearest: Well <br /> Foundation . ....... N <br /> Number .-.. .. ... <br /> "--. .-: Rock Filled Yes Eli <br /> o C <br /> Depth - ------ -- --'-' - Diameter <br /> - _ SEEPAGE PITS [ ] i� <br /> - Rock Size <br /> Water Table Depth ..- ---.. <br /> Foundation Prop. Line - �.._. ... <br /> l <br /> II <br /> Distance to nearest: Well --- "---...- <br /> Date ------ - --- --••-------------') <br /> I f <br /> REPAIR/ADDITION(Prev. Sanitation,Permit# --" :..- -- i <br /> .. ............. ' <br /> Requirement Septic Tank (Specffy q �1..- ... ' <br /> --•-----------••-------------- <br /> Disposal Field (Specify Requirements) ._..--- ---_- <br /> e <br /> ...... ......... .....— ...-.. <br /> p -..(Drawn existing and required addition on reverse side) <br /> of that al have prepared this application aqu <br /> and that the work will bocalolfcalth Distne in rict. Horneance toJvneI oh San r <br /> hereby cer y <br /> County Ordinances, State Laws, onc�Rules and Regulations of the San Joaquin I <br /> person in such magn <br /> .sed agents signature Certifies the followiing:�`�"�__ � p ._ to any p 1 <br /> "I certify that in the peorV�kdi'n's <br /> of the work for which this ermit is issued, I.shall not employ II <br /> as to becor su ctl<o.WCompensation laws of California." I <br /> .--- .Owner I <br /> ---- ... ------ ----------- <br /> t_�. . <br />. - ;� ................. Title - <br /> BY -' (!f other than owner) ' <br /> ` FOR DEPARTMENT USE,ONLY <br /> - - ---~—� DATE /�7 <br /> ..- I <br /> APPLICAT N ACCEPTED BY ........:... . .. ..... ------- 172 <br /> " DATE .............- ii f <br /> BUILDING PERMIT ISSUED :..._-.........._.. '--'-- '-' --'----------•............. --..--------....-... ' i <br /> ... ............ ........ ........................... <br /> ADDITIONAL COMMENTS .. ..---.:...... ----- --'- ' --- <br /> -"- --' ' <br /> _......... ,... " " ... 7� <br /> = . ...D <br /> ate - -•�- <br /> Final Inspection by:`- - <br /> it % SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i� <br /> E. N. 9 1-'6$ Rev. 5M ;i. - <br />