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r <br /> 4. <br /> ' Application is ' made o e an oaquln Loc ea th District far a permlf tb ennsfruc etri� stall the work are€n de , ad <br /> Thais.application is made in'convplian e with County rdinance No: 549. ; <br /> JOB ADDRESS ND LOCATION ................ .............• -------•-------...---................ <br /> Owner's Na Ctj.. Phone..:: �� <br /> Address__._ r --- -------_-"-------------------------- ------------------- ...._.•...... --- <br /> ------,- ----�-- --- <br /> • Contractor's Npma_.. .................. Phone_--- Y <br /> a Installation will serve: Residence [ Apartment House Commercial Trailer Court Motel <br /> p. ❑ ❑ ❑ ❑ they_❑.,,.:; ;,'' �,. . <br /> Number of living units. _1.... Number of bedrooms . Number baths ... .... Lot size ... C _..._ <br /> Water. Supply: 'Public system ❑ Community system F1 Private Depth to Water Table j ft. <br /> Y Character of soil to a depth of 3 feet: Sandp Gravel ❑ Sandy LoamClay Loam Clay Adobe . Har <br /> 'revious Application Made; Yes ❑ No New Construction: Yes WNE] C],o ❑ <br /> 'PE OF INSTALLATION <br /> AND-SPECIFICATIONS: <br /> ;mss (No septic tank or cesspool permitted if pu ic sewer is available within 200 feet <br /> p No. of compartments---------Z--_t------ Si e_!_ --�.__? ' `� qu cl 46 tb.�a ' ----------- <br /> --�fC packs i � <br /> 5e tic ank: Distance from nearest well Dista c om f nda <br /> Dispos I field: Distance.from nearest weilnr a� <br /> istance from foundation...._.....,...' istance to nearesf hof ine , <br /> I. [ Number of lines.......... ... ......... Length of each line................ Width of french_ <br /> Type of filter maferi ._ . .. Depth of filter,material---•--1X---......Total length., i ...... <br /> Seepage Pit: Distance to nearest well---___________-.....•Distance from foundation....................Distance to nearest lot line. . r <br /> Number of pits..................._Lining material.......................Size: Diameter..........._......_.....Depth.... <br /> .....:._._..:_.r� <br /> Cesspool: Distance from nearest well.......:.........Distance from foundation....................Lining material..........._............ p <br /> Size: Diameter............. ......... . ...De th------_--------` --_. ...--`- ------`-------.-..Liquid Capacity `.. t` <br /> ~Privy: Distance from nearest Well--------------------_______________..____._.-_Distance from nearest building..............-............ . <br /> ❑ Distance to nearest lot line................................................................................................................................ <br /> Remodeling and/or repairing (describe):...................•---------•--.-..-----------.--------•-_---------------•--...... ..........-------•_.... ------- ...' <br /> r <br /> ..............................-_..............._.....•....__..........----_--..._-........................................................................................................................ <br /> ....... { <br /> 4., ---------•.......-..................... -----•-----•-------------•-------------------•-•-----•-------------•----------------•--------•---"-------••----•--••---------- -----• 7 <br /> v2 --------------•----------,-_----•-•--».-..----.....---•------....__----------------------------------------------------------•--.._..-........ <br /> »......_.,..... ........... <br /> - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> ordinances, State laws, and rules an regulationsof t e San Joaquin Local Health District. <br /> (Signed) •---- -- -- --------------- " ---- --- f - (Owner and/or Co <br /> BY�-• -- --------------------- <br /> .....................••-........._............................--------•-------•---`-•--•---------•-•........---"- (Title].-................. - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can-be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B -- ----- ­--------­------- --------------------------------`--------------------- DATE..r...._...---------'------......... <br /> REVIEWEDBY................................. . ...............................................v.................----•---------`•-- DATE.... ' `.........�,�. <br /> BUILDING PERMIT ISSUED----------------------------------------- --------------- --------------------------- -•---- DATE..-----• # <br /> Alterations and/or recommendafions:...............................................___..__._..._____.._.....I._..._,_........... <br /> ...................... <br /> ...__.. <br /> _. <br /> A <br /> • <br /> w <br /> ef <br /> �. <br /> �'f Js.:i•'�s���---._�.-fig-._�__.�.��L,:nti�„�,rk��.� --h„s�..°-�r `;mom ��,. ' ��„ r <br /> _��., .�-x-�---�---�-_- . <br /> ... <br /> �- <br /> , - � - -4------ <br /> FINAL SPECT30N BY:.--�- - - ------- ------------------------------�-------- Data...�� �v� \ <br /> i <br /> 4-f 7A:fhtA� �JF,eY gra e-66vel- 02 <br /> ' v SAN JOAQUIN LOCAL HEALTH QISTRI <br /> 1 130 South American Street' 300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> Stock+on, California Lodi, California <br /> Manteca, California Tracy, California <br /> x ES-9--2M 8-51 Ra,4ed W. - <br />