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s <br /> FOR--OFFICE f# USE: APPLICAVON FOR SAIV TATION PERMIT <br /> ..........................I.......................... Permit No. ._.✓.�` <br /> }Complete in TriplicaNl _ <br /> »........:.......::..............._... This permit Expires 2 Yearfrom bow Issued <br /> Date Issued .,,r�.'.n. ..r <br /> Application is hereby made to the San Joaquin Local health District for a permit to constrt;d and install the work herein <br /> described. This application is made in compliance With County Ordinance No. 54+9 and existing Rules and Regulations: <br /> JOB ADDRESWAOCATION _. K..v..�..•�. ......`.............�.�..'"�pir?........�c�`�?................CENSUS TRACT .. ...... � <br /> Owner's Name .!91 ............�-'�. !i#)�.I . .....» .................................................Pl ane ............. <br /> � ._.._. i <br /> Address ... ? 1 l�1!N.....'.!r.'?:.....................».......(ity ..f��r�rl0t i <br /> Contractor's Name......G69G=_lir".:..................._.........---........_---..,..._....Lirgnse$ 2q l it 9... p}xs� cl"' 3J............... i <br /> Installation will serve. Residence 0 Apartment House fl Commercial OTraller CAW 0 <br /> ,Motel Q Other...�Y A511 !`� <br /> Number of living units:............. Number of bedroom ..._......krs� Gunder _......._.... Lot Siwe ....q.... <br /> Water Supply: Public System and name ............................» .......»........................ »._..,.»»_......................_...private <br /> Character of soil to a depth sof 3 feet; Sand M Silt❑ Clay 0 Feat[] Sandy Wm(3 Clay Loam 0 ' <br /> Hardpan 0 Adobe 0 fill M6terlal............if Y".type.............».,........... <br /> . <br /> (Plot plan, showing size of lot; location of system in relation to wells, buildlt+Rt, eft mud be placed on reverse side.) E`}J <br /> NEW INSTALLAItON: (No septic tank or seepage pit pwtttWo d if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT l ] SEPTIC PANIC Siwe...��_j.�..��} '�. r._.._..... Liquid Depth th..` <br /> ' Capacity ..1.1 P9 "..Yppe jqMateriol_p �! No. Gunp artments ...... ......... `xi <br /> t <br /> Distance to nearest, Well __.__� .foundation ....................... Prop. Linux -__ ...... <br /> LEACHING LINE it j No. of Lines .......1............... Length of each fit*...._..��............. TOM! Length <br /> - 'D' Box .A ...... Type Filter Material ..'JVO....._.i3epth Filler MaWlal .....i�....j.....................»......... <br /> } Distonce.to nearest: Well ....i9A.......... Foundation —.26,.............. Property Line ...a�J.�........,,..,.. <br /> SEEPAGE PIT (i} Depth Diameter ................ Number ............................ Rock Idled Yes C3 No(3 <br /> tWater Table Depth » .....,....»............»........w.._...itocic Size ................................ <br /> t � Distance to nearest: Well ......................................Foundation .................. ftqL Line .............. .r. <br /> REPAIR/ADDITION(Prev.-Sanitation Permit'+lOi... ............. Late .........-..... <br /> Septic Tank (Specify;Requirements) i................n r ........ . ...........».........,.....»....».................,...........,,........_..».. <br /> Disposal Field (specify-Requirements} ............ ....�.......� ...,..................... ,..................... .....................:.......,. _... <br /> ....... ...,. »..........................»,_..»................_...... ................ .. <br /> ...._.....- . ...... ....` V"'(Drow existing in_d:hi;g6*ed'additlon o n revertA side} <br /> a ":=`::=''";;`=' <br /> I hereby certify tht i'hmr*prepared this application and that the work will be den* in accordance with San Joagalrt <br /> County Ordinances, State taws, anti AuNs and Regulations of the Scorn Joaquin Local Houlth,I)Istrict. Noma aw"M or iicwl- <br /> sed agents signatures certifier the following: <br /> "I certify that In the pe rfaimance of the wo&for'which this permit is issued, l shall net employ city person in such ownaw <br /> as to become subject to WN rkman's Compensation laws of California." <br /> Signed <br /> ........... .__... ................. Owner <br /> By .. .. _yam,. .............., ........».,....»..Title . <br /> Ofmar Chart...... .............. . .. ...................................... ....................... ,.. <br /> R 6Alt ENT U E ONLY <br /> APPLICA'T'ION ACCEPTED BY.... _ ..... ..:. _.., µ... ........ DATE _... ...� .7r. ... <br /> BUILDING PERMIT ISSUED .........................._.... .DATE <br /> ADDITIONAL COMMENTS .. �......-,�. ...... ................................................ .................................. .. <br /> ........................................................,,..? �-'�i.I...1 � -2 .»........._.....................�.... .....»..,. <br /> Final Inspection b............... <br /> : .................... :..:::::.::»�..: .:::,:::::::::::::::::: ::: .: <br /> ' � 13 2!� 1-bi3-..qtr.•�..... SAN ::�::•� . .».... . . ...... ...... .... .,�.,ls� ::�:...:...:..��. <br /> K)AQUIN"LO"CAL HEALTH DIVOCT /'ale 3M <br />