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FOR OFFICE USE: <br /> -------------------------------------------------------- APPLICATION F6117iSA4 NITATION PERMIT Permit No. <br /> --------------------------------- ----- <br /> -------------------- ---------- --------- (Complete-in Duplicate) Date Issued <br /> ----------- ----------------------------- - This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> O-�--------- ----t------ --------------------------- <br /> JOB ADDRESS AND LOCATI <br /> -•-•----f.. <br /> --- - I -------------------------------------------------- -Owner's Name----- _c; ------------------------------------- Phone---e <br /> Address----;DAL04-------- -------9.Y.Z:�------ _;6� --------------------------------------------------------------------........ <br /> Contractor's Name--- --- ---------------- ------- ---___------ ------------------------------ Phone-, <br /> Installation will serve:Tesidence K Apartment House E] Commercial E] Trailer Court E] Motel E] Oth'er ❑ <br /> Number of living units.... ..... Number of bedrooms .3-- Number of baths -------- Lot size ------------------------- <br /> d <br /> Water Supply: Public system E-] Community system [] Private D? Depth to Wafer Table ft <br /> Character of soil to a depfh of 3 feet- Sand C] Gravel E] Sandy Loam El Clay Loam El Clay El Adobe I-] Hardpan 11D <br /> Previous Application Made: (if yes,date--....---------- No El New Construction. Yes E] No 0 FHA/VA: Yes E] No F <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No-'s-elpfic fank-or ces-i'pi-66-1 pe�rmiffecl if public sewer is-available <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation_..-----_--_.---- -Material -------- -------- ------------------------------ <br /> El No. of compartments--------- .....Size------------.-- -- ---------_`Li uid clepth--------- -_... ........Capacity----------------------- <br /> Disposal Field: Distance from nearest w0_670.....Distance from foundation----/P---------Distance to nearest lot line----57....... <br /> Is Number of lines --------------/-----------------Length of each line-- -------- Width of french..---Z------------------------- <br /> Type of. filter material----- of filter material-------17........Total length......_. 40-0------------------- <br /> Seepage <br /> 0-0----------------- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation-----------_------Distance to nearest lot line__--__.--------_ <br /> ❑ <br /> ine----------------- <br /> El Numbei of pits--- ------------------Lining material----- .................Size: Diameter-----------------------Depth-------------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation Lining material--..._._____..._--.----..-----------. <br /> Size: Di8meter. ------ ----- ----------------Depth--------- ------------------------------------------Liquid Capacity- ------------ -------------gals. <br /> Privy: Distance from nearest well--------------------------------------------- ---D.Istance from nearest building-_-_-_-.-_.__.______.___--____.---_..._. <br /> ❑ Distance <br /> uilding------------------------------------------ <br /> Distance to nearest lot line - - ------ - ------ -- -------------------- ----------------------I------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe}:-------- ----------------------- ------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------- ---------------------------------------------------------------------------------------------- -------------- -------------------------------------------------------------- <br /> ------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ <br /> I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County <br /> ordinances, State laws, and rule�_,ancl regulations of the San Joaquin Local Health District. <br /> (Signed)--------- ...... ----------- ------------------------------(Owner and/or Contractor <br /> ----------------------- - - ---- - ---------------------- <br /> --------:------------------------- ...........77414---—------------- <br /> ---I------ ---- -------------- <br /> (Plot plan, showing sixetof lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT SE ONLY <br /> - ----------------- <br /> APPLICATION ACCEPTED BY._. ----------------------- --------------------------------------- ----- DATE-- I------- <br /> REVIEWEDBY--------------------------------------------- m-------------------------------- ------------------- - ------- DATE-------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ------- --------------­--- --------------------------------------•--------------------- DATE-------------------------- <br /> Alterations <br /> ATE----------------- ---------Alterafions and/or recommendations:------------------------- -------____------------------------------------- ---------------- ------------ ------r-------------------------------------------- <br /> ­ ------------ ------------- -------- ----------- ............. ---------------------------------------------------------------------------- --------------- --------------------- <br /> -------------------------- ------------------------------------------------------------------------------------------------------------- ---------- ------ ------------- --------- ---------------- ------------------------- <br /> ­----------------------- ------ ................ - ------ - ---- - --- - ---------------------------------Z------------------------------------- ------- -- --- ---------------------------- <br /> ................................ ------ <br /> FINAL INSPEC ...... ...... . ... . Date--- -. .............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20S West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> F.H.9 2M 1-67 Vanguard Press <br />