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O;I�FICE USE: <br /> >- <br /> -------------------------------------------------- APPLICATION FUP .-ANITATION PERMIT Permit No. 4P.1i _ <br /> ------------ - ---- -------- --- ---- --- --- --------- - (Complete in Duplicate) �f <br /> Data Issued <br /> -------------------------------------------------------- - This Permit Expires-1 Yeai' 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 /> JOB ADDRESS AND LOCATION-------- >--------------------­­---------------------------- ------------ -----•------------ <br /> � , <br /> Owner's Name- ---- �!e''- -------1Ve-L-Z-1-�-------�`- <br /> 1 ------- ----------- -- Phone'¢ -- �--- <br /> --AddAddress------------------- <br /> ress---•------------•-- ........ --- 6'---------------------------------------------- ---------------------•------------------------------•----------------------------------- <br /> Contractor's Name--------. r_ ---------- ---------------------------------------- ------ Phone.-_' 5.�. _�?.44? <br /> Installation will serve: Residence [!r--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel O k Other ❑ <br /> Number of living units: I---- Number of bedrooms...,--- Number of baths __2 Lot size __11 - d_ <br /> ------------------------ <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 1!r�c lay ❑ Adobe ❑ Hardpan b — <br /> Previous Application Made: (If yes,date------------------.-) No ®lNew Construction: Yes ❑ No L� HA/VA: Yes ❑ No [ 1- <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 /> ❑ No. of compartments--------------------------Size--------------------- -----------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well-- Distance from founds ion-49---_---.-..Distance to nearest lot line_.-,�_.__... � <br /> Number of lines---.--__-/.______ _Length of each line-y_ri __ P..l�rWidth of trench.___ _"---------------- <br /> Type of filter material._-_,`s�. 14� Depth of filter material__/ y___._____Total length-------4Q--- <br /> .-__----------------- <br /> Seepage Pit: Distance to nearest wefl-_____________________Distance from foundation--------------;::__:Distance to nearest lot line----------------- <br /> � . <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_--_.______...__._....Depth----------------------- <br /> ----__---- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----------------...Lining materiaE__._. -------- _----_--_ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. i <br /> Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building --------------------------- <br /> Distance <br /> ---.--.._-_-----.----_--_Distance to nearest lot kne------------------------- ------------------ ----------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---------- / -----la-------- _; . ------- ./1 ----------------------- <br /> ---------------------------------------- ------------------------------------------------•-------------------------------------------------------------------------I----------------------------------------------r------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stap�ules and regulations of the San Joaquin Local Health District. <br /> (Signed)---------------------------� 1 /, / �/ ----- --- ---------------------- -------- - ------------ - w rand/or Contractor) <br /> r--- -- <br /> By:-------------- A.�— ....p--------------------- -------(Title)--- ` <br /> (Plot plan, showing size of lot, Iota on of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> j <br /> APPLICATION ACCEPTED BY......_... ALL_ -_ DATE--- ` � -J <br /> ---------------------------------------------------------- <br /> REVIEWEDBY-------------------------- ---- --------- ----------------------------------- --------------- ----------------------------- DATE---•------------------------------------------------------- <br /> BUILDING PERMIT ISSUED----- ---------------------------- ------------------------------------------------------------------ DATE---------------------------------------------- ---------- --- <br /> Alterations and/or recommendations:------------------------- <br /> ----------------------------------------- ------ ---------------------------------------------------------- --------------------------------- ------------------------------------------------ -- ---- ------------- <br /> ------------------------­ <br /> ------------------------------------- ------------- - - -- - ------ - -------------------•---------------------------------------------------------------------------------------------------------------------------------------------- <br /> i <br /> FINAL r INSPECTION BY:------C ..._..- c .2 5-------------------------- Date----- <br /> l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad!,California Manteca,California Tracy,California <br /> F.P.co. �y � <br />