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FOR OFFICE USE: <br /> . 'LIGATION FOrIt',NSAMTATION PEP r <br /> Permi7 <br /> (Complete in Triplicate), <br /> t No.�5.. J /• i <br /> .......� .;� .� ........ <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance!No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _ 1 --- -- �� �°s�.-. .., C . ... . ...CENSUS TRACT - - <br /> Owner's Name .. ... . . ..... ........................................ :Phone .......................•............ <br /> .... <br /> Address ....... ................. ....................... . ...........-.-----...... City ---.... . . .......... .............................................. <br /> Contractor's Name .. _ , -17Z-7 <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Troiler Court ❑ <br /> Motel Other . .. . <br /> Number of living units:..o2.2-Number of be ooms .2-2—Garbage Grinder " _ l.Ot Size <br /> IS <br /> Water Supply: Public System and name . . ... . �s, -• - . Private E] i <br /> ,r- <br /> Character of soil to a depth of 3 feet: Sand D Silt ElClay ElPeat,❑ Sandy Loam (:1 Clay Loam 11 <br /> Hardpan ❑ Adobe Fill Material;.':... if yes, type .. ..... ... .... ....... . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) , <br /> NEW INSTALLATION: (No septic tank or seepage pit perrr}iftted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK S <br /> rze....... .......... ...... ............ ." .... Liquid Depth ...--------------._......,� <br /> 1 N7`F tic'&pacity �p'.� � Type Material. .. No. Compartments .17...............5 ` <br /> .....Foundation .../.....f Pro tine <br /> Distance to nearest: Well �� . ... .......... © -- --- p• . � ------[ <br /> LEACHING LINE No. of Lines /G ..-. Total Length ._... Q. ............ <br /> Length of each fine:z ...... <br /> ...... <br /> i . <br /> 'D' Box Type Filter Material ... ._ Depth Filter Material ... .......................... <br /> 11 <br /> Distance to nearest: Well ..w._ --.... - Foundation � .-.-- . -- Property line -- ------------------ <br /> SEEPAGE PIT Depth ��.-- Diameter �J-------_ Number �. ......- Rock Filled Yes 0 No 01 } <br /> - F � <br /> Water Table Depth C'��------------------------- r Rock Size - ..-.. ------.----...-.- F <br /> Distance to nearest: Well ._/_ ..-...- ""...............Foundation+ ."-/.- Prop. Line AC----------- <br /> ` } <br /> ( ^� 1-7 <br /> REPAERjADDITiON(Prev. Sanitation Permit# ....25— � <br /> .- <br /> . .5 - -. --- -�-�-... Date --- � --•�• - - <br /> Septic Tank (Specify Requirements) . ------- ............. t!-- . r.... I <br /> . <br /> Disposal Field (Sp cify Requir ts) ° ''` <br /> ............ ...-./� ---..... .�._" '.._. ._._... '...._. ter/ ...�a'f.��.l.f-__ _ .... .. .._.....- - � ....__. <br /> I i <br /> [Dw existing and re red addition on reverse side) } <br /> I hereby certify that I have prepared this application and that the work.will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. [donne owner on licen- <br /> sed agents signature certifies the following: p <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 laws of California." <br /> Signed { c <br /> ------ Owner. -- <br /> BY Zeit.............. .... .. .. Title — �. ..1..4...�.Q. � <br /> . . <br /> Vio�thers thea Own - - - -FOR DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED BY �I <br /> DATE <br /> BUILDING PERMIT ISSUED ... DATE <br /> ADDITIONAL COMMENTS .E <br /> :. ............. . . ............. ..... • --- ----- - <br /> ----------------.................---- <br /> ..... --..._ ----- ----. ---- <br /> e <br /> Dat <br /> ...... <br /> Final Inspection b <br /> SAN JO QUIN L L HEALTH jPISTRICT J <br />