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FOR OFFICE USE: <br /> ............................................ <br /> APPLICATION FOR SA IITA ION PERMIT . Permit No. _ -- -- <br /> -------------------------------- (Comple+e-in Duplicate) <br /> Date Issued <br /> This Permit Expires 1 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 Ordi nce. No. 549. <br /> JOB ADDRESS AND LOCATION , �... � �- -- -- ------ <br /> / /� ------- <br /> Owner's Name------ WO----- ---------- -------- -------------------------------------------- Phone------------------------------------ <br /> Address .................. .z-va---- <br /> Contractor's Name--------------------------- <br /> 4-r- .-�•--- <br /> -- - Phone 44MAJO/------- <br /> Installation will serve: Residence 0( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ �___ Number of bedrooms . .Number of baths --- Lot size ..-. ------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Privateg Depth to Water Table 9S'ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,[ Hardpan ❑ <br /> Previous Application Made: (If yes,date-.-__.__._....__'. J No X ;New Construction: Yes ❑ No FHA/VA: Yes ❑ NoK <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank,or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation...........-------- Material ----------------------------------.------------- <br /> ❑Fjt.16,f fAA; No. of compartments--------------------------Size.................... ------ _ Liquid de th_.------. . ----- --- <br /> --._Capacity--•--- ---------------- <br /> Disposal <br /> ------------Disposal Field: Distance.from Weare t well-.4PQ. ....Distance from foundation Vic....-..Distance to nearest lot lin.'•-'�..._�-.- <br /> Number of lines _- ..C.).)k------- of each-line.....7�..............Width of trench-__ ....---------.-.....__ <br /> Totai length - ----------------- <br /> Seepage <br /> ------•----- -- Q <br /> Type of filter materiaVDepth of filters m�teal.. _ !-____._ ._ g 'L <br /> Seepage Pit: Distance 1c,4earest-welf_ :_-..............._Distance from foundation'-_.-.........Distance to nearest lot line----- ........... <br /> ❑ Number of pits... .-----------------Lining material---------------------- Size:'Diameter...................----Depth---------- ---------------------- <br /> Cesspool: 4, Distance from nearest well ...____...__...Distance from foundation................. ..Lining material-----------..........._.-___.__... <br /> ❑ Size: Diameter Depth---- ------- ------------------------ ---------Liquid Capacity-------------- -------------gals. <br /> EPrivy: Disfance:from nearest well-----_____---___--- -----._------------.------- _Distance from nearest building----.-----_-------.----------------------- _ <br /> ❑ Distance 'to nearest lot line ---------- --------------------------------------------------------------- <br /> Remodeling and/or repairing <br /> ---------------------------------------------- --- <br /> _. --- •----- --------- --- <br /> ` F <br /> I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, ' d ules and regu0plons of the San Joaquin Local Health District. , <br /> (Signed)-------------- -------- � - -F ------ (Owner and/or Contractor) <br /> B ------------ -------- L-L `- -- - ----- Title h . --.... F <br /> --, (Owner <br /> plan, showi ze of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----___..._ f_ _t -----------•:------- ------------------- DATE-- <br /> c = <br /> IREVIEWED BY------------------------- ---------------------------------------------------------------------- •--------- DATE------ --- --------------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ------------- ------------------------------ ------------�`-- DATE <br /> Alterations and/or recommersdations -----------------.-..-_--- -_ -_---- <br /> _ .. ,.. <br /> ---------'------- ------ ----------------- ------------------------------- - ., t <br /> !�- ----------- ® !ems° <br /> w <br /> ����_�__.�_-�G. i <br /> _411 <br />` FINAL INSPECTION BY: - :.. ate --•-------- -- <br /> : .j/�'��ro/ o.-.rc�-•.*�._. <br /> S NV�UIN LO)FAL !$ALTH DISTRICT <br /> i 1601 E.Hazelton Ave. 03 0 West Oak Str4t 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California M Manteca,California <br /> Tracy,California <br /> E.H.9 2M 1-67 Vangugrd Press _ <br />