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FOR OFFICE USt- <br /> 100 f_'?P ------- PPLIMATION FOR 'SANMTION PERMIT//t,'-/ - % W Permit No.70 <br /> (Complete in Triplicate) <br /> --------- --- -------------------------------- ------ Date Issued/_1.1.20..-------------- This Permit Expires 1 Year From Date Issued A, <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. 549 and existing Rules and Regulations: <br /> TRACT -------;�P .... <br /> JOB ADDRESS/LOC TION __0 <br /> Owner's Name .... - ----- ---- -------------------------------- -------Phone ---------------------------------- <br /> -------_------- <br /> ----------- - ------- ----------- y <br /> Address ---cQ-.3---0 Ci ---------------------------------------------------------- <br /> icense # Phone <br /> Contractor's Name --- <br /> Installation will serve: Residence Apartment House-[] Commercial :[]Trailer Court <br /> Motel F-1 Other -------------------!-------------------------- <br /> N I umber of living units:--- Number of bedrooms __3__._ Garbage Grinder _AvPL4-,Lot Size --------------- <br /> ---------Private <br /> Water Supply: Public System a 1]3fme <br /> -------------------------------------------------------------------------------------------:---------- <br /> ,Character of soil to a depth of a feet. San&[]. Silt:[]- Clay. Fl. Peat El Sandy Loam El Clay Loam El <br /> L -Hardpa,,.n F-1 Adobe-[] Fill Material ------------ If yes, type ---------------------------- <br /> (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION (N septic tank or leepage pit permitted if public s we is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TAN!K.-:J Size----- Liquid Depth ------------- <br /> Type A-64404-er Material---6KO-111 - ,No. Compartments ---- <br /> Capacity/0-404-J. .- .. : - --- <br /> .01, <br /> Distance to nearest: Well----------/0A----- ------------Foundation ---/0-_---________ Prop. Line -- ---------- <br /> LEACHING LINE No, of Lines -------- Length of each line----' ------------ Total Length ----- ---------------- <br /> D' Box <br /> ---------------------_-- <br /> Depth Filter Material -------/ <br /> ' p _A�qk--------- <br /> Type Filter Material <br /> 111' Line ----- <br /> Efistance.-to-nearest.,Well .6-0---------- Foundation 0------------ Property ----------- <br /> 'No 0 <br /> SEEPAGE PIT Depth4--_____ ----94'Number -_____--- -1-___ Rock Filled Yes <br /> Ki T ? <br /> -------- k�Jze ---------- A <br /> "Waiter Table DeptW ---------- -6------1/------------ <br /> ------------- Prop. Line .... --------- <br /> Disia'nce to nearest: --------- Foun ation <br /> REPAIR/ADDITION(Prev. S 'nitation Permit Y# ------------------------------------------ Date---------_`_'_-__"_--_---------------) <br /> Septic Tank (Specify Requirements) -------- t-------------------- -------------------------1---------------------------- <br /> Disposal Field (Specify,Requirements) ----------------------------------------------------- --------- ----+-.--- ----------------------------------------------------I------------ <br /> - - --- <br /> --------------------------------- ------------------------ <br /> -------------------------------------- --------------------- ------------------------------------------------------------------------ <br /> -------------I- ---------------------------- ----------------------------------------------------------------___­--------------------------------------------------------------------------------4------- <br /> (Drowexisting and required 'addition on reverse side) <br /> I hereby certify that I have prepared thii application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, StateLaws, and RAes Viand Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the 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 ------------------------- Owner <br /> e�117----------------------- -------------- ---------- <br /> By --- - ---- -- -------------------------------- Title - --- --- -------------------------- <br /> (If other than owner) <br /> 4Qn�PARTMENT USE ONLY <br /> -------------------- <br /> APPLICATION ACCEPTED...BY --- ------- - - - -------------------------------- DATE ---//—. --171 ----------------- <br /> BUILDINGPERMIT ISSUED --- --- - --- - -- - - -------- - ----------------------------------------------------- -----DATE _/---------------------------------------- <br /> I - --------------- --- ------ ---------------------------------------------------------- ------------ <br /> ADDITIONAL COMMENTS - -- -- --- ---- - ------ - ----I--------------- <br /> ----- -------------------------------- ---- -----------------------I------------ ------------ ---------------------------------------- ---------------------------------------------------------- <br /> -------------------------------------------i------I-------------------------t----------------------- ------------------------------- --------------------------------------------------------------------------- <br /> -----------------------J:------- ----------------------------------------------------- ---- ------------------ <br /> -------- ----------------- ------- - - Date -- ----- - -- - -------------- --- <br /> Final Inspection by- ---- ----------------- <br /> - <br /> AN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />