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--"� i-tk€€Vrw !-vrt. ai AN f r A F FV.N PERMIT <br /> icompletein dripl)catet ?`:_. Permit No <br /> This Permit Expires I Year From Date Issued <br /> 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 opplication Is made In compliance with Cou ty Ordinance No. 549 and existing Rules ar.d Regulations <br /> /J .-s <br /> .LOB ADDRESS/LOCATION ..�i.. ...... ... ..... .......... ' ...; ...............................CENSUS TRACT .......................... <br /> Owner's Name .� �j � :�' . ..................... .....Phone <br /> Address .✓ . .............................. ` - -------------------- ...... .......... .. <br /> Contractor's Nams . Phone-----------•-----•----------------------••....License ....................... <br /> Installo6on s <br /> will serve: a deuce[IjApartment House{] Commercial ❑Trailer Court ❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units------------- Number of bedrooms .5—------Garbage Grinder ------ Lot Size .-----------------........................ <br /> Water Supply: Public System and name ---------------------------------__--------------------- --......................... ................Private 2- <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ <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 permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size................................................ liquid Depth ........................ <br /> Capacity/.(/n ype ---------------------- No. Compartments Z <br /> Distance to nearest: Well ______________Foundation ---------------------- Prop. Line ...............�.... <br /> LEACHING LINE No. of Lines -__----------------_- Length of each line-__._....--..... <br /> [ ) � g ��J .._..------ Total Length .��f................. <br /> 'D' Box .../------- Type Filter Material .01Z�A ...Depth Filter Material ..�1 ................................ <br /> Distance to nearest: Well ........................ Foundation -....................... Property Line ....................... <br /> SEEPAGE PIT [ ) Depth -------------------- Diameter ................ Number -..-------.................. Rock Filled Yes ❑ No <br /> (Mater Table Depth ---------------------- ------ ..................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line --------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ..------.-----.---------.-------_.) <br /> SepticTank (Specify Requirements) ................... -----------------------........................................--....................................................... <br /> Disposal Field (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------•-------.....--------..............-------•---------•-•••----•---•-----••--------------•-•-•--•------•-..............................-------•---••--•-- <br /> ............................................... ---------- ...................................•-............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, Stato Laws, and Rules and Regulations of the San Joaquin Local Health District. Nonce owner or licen- <br /> sed agents signature certifies than following: <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 ---L-�i&- .. .. Owner <br /> By .. ......................................_............................. -------•--------------------- title ..............-.................... -- <br /> (If other than owner) <br /> FOR DEPARTMENT 14SE ONLY _ <br /> APPLICATION ACCEPTED BY ...... .... �.... . . ._ w � lFz�y'... DATE .-... .:................:: <br /> BUILDING PERMIT ISSUED ....................... ........... ......•----..(... -..........._........ --- -��--.._...._..DATE . ............................7............ <br /> ADDITIONALCOMMENTS ....................... . --••------._.................................................................................... <br /> ................ .... . .......................•-------------- ---•--------•-•------ ----- •---........------..........----- -••--..._......-- --......------...._.................... <br /> ---------- - ----------------- - -- --•---••----.........------------.................................._.....--...............................................: .................._..... ...... <br /> r <br /> Final Inspection by- ------------------- t.°?�s'.F.....Date .-.... `_: `"f �lr................. <br /> EH 13 2lt 1-68 t�v• 5 f SAN JOAQUIN LOCAL HEALTH Di.STRICT 8/7h 3M <br />