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FOR OFFICE USE, APPUCATI PMA Fop, PERMIT <br /> pen-nit <br /> Date Issued <br /> -------- --- -------------------------------- This Permit EltPires T. `Yeas FromDate Issued <br /> :m Joaquin Locai Health District for a perrrit to construct and install the work herein <br /> Application is hereby made to the S( County Ordinance No'. 549 and existing Rules and Regulations- <br /> it <br /> described.�cc <br /> ribed.This application is made in compliance �Mth AA, <br /> TRACT -eZO= <br /> JOB ADDRESS/LOCATION V*_v%-Z---------WA_ ..................Phone .......... ................... <br /> . X_f4�_. .-••-----•-•. <br /> Owner's Name -------- <br /> 14' .................... <br /> S Ad.........city i�4 <br /> Address ...........02p..0.0,9...... -1 ------------------ <br /> Contractov'3 Ndmd ----- License# Phone ................ <br /> -­--------- ..... <br /> ' l stallation will serve. Residence E]ApoTtment House I[:] Commerclal,C]Trafler Court 0 <br /> er_401aA9 ._4V <br /> Motel [I Other ........ . <br /> Number ®f living units:_--_----- <br /> _• Number of bedrooms ............Garbc�gs Grinder ---------- Lot Size --------- ------ <br /> Water Supply: Public System and name ............................................------- ........_I............................... .......Private <br /> Character of soil to a depth of 3 feet: Sand'.Q Silt 0 Clay Fj Peat Ef Sandy Loarn ,[D Clay-Loam'13 <br /> Hardpan F1 Adobe-0 Fill Material If yep,iYPS ... ------ <br /> EPlw pion, showing size of Jot, location of syste <br /> rn in relation ja wells.. buildings, etc. must be placed on reverse side-1 <br /> MEW WSTALLATlON. (No septic tank or seepage pit permittee) if public sewer is available viflthin 200 feetA <br /> 1' -- ......... .... Liquid Depth'S�....................... <br /> SEPTIC TANK:[ . ...... �e?p <br /> PACKAGE TREATMENT giments ............... <br /> Capacity Type ..&*A" Material-g-en-----_------ No. Con pa <br /> Frop, Line <br /> Distance to nearest. Well `-i....... ..............Foundation ... .... ...... <br /> No. of Lines .._....3------------- <br /> ......3---­-------- Length of each ling......... <br /> Total Length ...LOA------------- <br /> ,7C,9� 7Z�7.-2 7, 'D' Box Depth Filter Material ........ .................. <br /> ' j' 'Ve ------ Type Filter Material ion -------....... Property L!.ne. ------........... <br /> _11�7,�0 Distance to 'nearest; Well .........1-0.0------- Foundat <br /> *: Number ............................ Rock Filled Yes [I NO <br /> ........... <br /> SEEP-AGE PIT f --------------------- Diameter <br /> Depth1E <br /> WaterTable Depth ........-------------------------------I--------Rock Size -------------------•--- <br /> i...............Fourdation ....... 11ne ................°.°__ <br /> Distance to nearest: Well ....................... <br /> Date --------------------------------- <br /> RSp,AijR/AoD4jj0N(Prev. Sanitation Permit# ------------ ------------- <br /> .1........... ...... <br /> ................ ..................... ....................... <br /> Septic Tank (Specify ReqUir4mentsl'.7--.- 6... 1C <br /> . ,, � - - -— ,- :... ...................................... <br /> pecify*Requirements) -------- -----------------------------•-_-.Y....----••._...._.. <br /> Disposal Field :(S .......... <br /> ..................11............... <br /> ............ <br /> ............:............................................ <br /> ...............I........ <br /> --- ---------- <br /> -----------------------------------------------------------------------------------------------ve rse s!del <br /> ............................V_ fDraw existing and required addition on re <br /> U WAII ba d@no in acwu'ddfl(�G hh Son Joaquin <br /> I wad this C-IF4 tha�, the W06� <br /> PveRg M W <br /> nd Rues afid RequWqons o� +a fan Joaquin Laca� H90hh No s @ <br /> jraigj� n(,ees, State Lvws, a <br /> 3-0g,,O,ure <br /> certifies�tj,q lollmOng ampO®y @Inrpmt(trm�r In ,w(� @ <br /> 'ed agL ®f RhewoAft Perm�R h%: is <br /> '4 ceoify qhw rin the par�wffidnce <br /> compensaflan law_q *q Callifornic." <br /> Signed ------------__----------- ------------- <br /> ntle <br /> -----------------_-------- ...... <br /> (If 011her 1han owner)' I <br /> FOP.IDEPAtTMEM7 USE-omy <br /> DATE ................. <br /> .................... <br /> APPLIICATION ACCEPTED BY - .............DATE .......................................... <br /> T ISSUED ............................................:__.... -------- <br /> BUILDING PERMIT ......................I...................... ..................... <br /> ADDITIONAL COMMENTS...:_.....r......^............................................................7- <br /> i -:t........!---------N-1-1------"I'll,--------I----------------------------------------------- <br /> .............. --------1-------- <br /> .............. ......... . .........I...................................................................... ------ <br /> .................................................... I .......... <br /> .............."I...... - -------- ........................................................... ....... <br /> .......... ............... ...... <br /> Date <br /> final Inspection by- ------------- -I-, ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E°H. 9 1-'68 Rev. 5M. <br />