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FOR'gFFICE USE: <br /> ------ --------------------------------------------------- <br /> APPLICATION FOk ANITATION PERMIT Permit No. <br /> -------------------- 7------ 7- (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 <br /> a permit to construct a the work herein described. <br /> This application is made in compliance with County Ordinance No.�49.[ &63Z '6�--,3 L5. <br /> LoT4t-t5 4t- /7-19 --/7- 2c, T <br /> JOB ADDRESS AND LOCATION C ...... ...... . ------ <br /> 1------------------------------ <br /> Owner's Name-------•------•- --------(_:�- -------60--------------------- Phone-----•-------------•---------------- <br /> Address-----•------4P-0'_1-----1320.�---------3_0��--------- -----------------------------------***-------------- -------------------------------------- <br /> Contractor's Name-----------------avut\L�T�;.Z---------- ----------------------------------------------------------------------------------- Phone.._..---------------------------- <br /> Installation will serve: Residence ED'Apartment House E] Commercial Ej Trailer Court E] Motel [_1 Other 0 <br /> - 16CA---;50------------- <br /> ------- <br /> Number of living units: __1---- Number of bedrooms '2�--- Number of baths /.--- <br /> Lot size ----- <br /> Water Supply: Public system Community system F1 Private 0 Depth to Water Table --5"- ft. <br /> Character of soil to a depth of 3 feet: Sand �rGravel ❑ Sandy Loam El Clay Loam El Clay ❑ 'Adobe C] Hardpan 0 <br /> Previous Application Made: (If yes,date- --- .............J No'B�New Construction: Yes 0-14o ❑ FHA/VA: Yes gj1 No E] <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--4;4t/'_Distance from foundation----/0-------MaferiaI__Q�_C___KT;i- ------- <br /> n No. of compartments__-.�Z----.-_.___._..Size-3XIO-Y57_Liquid depth....f <br /> Disposal Field: Distance from nearest well.-C.,-AW.-Disfance from foundation--------------------Distance to nearest lot line---- <br /> Number of lines----------- - --------Length of each line--- --.Width of trench--- ------------ <br /> Type of filter matDepth of filter material-----n__ <br /> r . ----i <br /> -- <br /> ---------Total length----------/,/_451--------- -------- <br /> --R!------ <br /> _.t A- I <br /> Seepage Pit: LDi-stance to neare0­well-------_--____-_'___Distance\from foundation--------------------Distance to nearest lot line-_-.-.-.--.----_ <br /> ❑ Number-of,pits_mrir:--- -1ining 1 material___-._w---- -- Depth--..-.--.._-_-.-.__-_!!I----- <br /> Cesspool: LDisfanco-from nearest we4-----------r ------Distance from foundaf 'Lin"ing- <br /> - - ---------------- -------- <br /> Depth-- _-A <br /> 0 Size: Diameter------------------------------- ------ - -------------------------------------------Liquid Capacity--- ----------------2�gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----I----I---- -------------------------- <br /> .. 1 - — <br /> ❑ Distance to nearest lot line-------------------------- --I---------------- -A--- -------------------------------------------------- ------------------------ <br /> t- <br /> Remodeling arid/or repairing (describe):-------- -------- -------------------------IL------------ ----------------------------------------------------- ------------------------ <br /> --------------------------1-------------------------------:--------------------------------------------------------------- <br /> 1------------------------------- ------------------------ I----------------------------- <br /> ------------------------------------------------------------------------------------------­----------------------------------------------------------------------------------------------------------------- ------ <br /> II <br /> --------------------- -------------- --------- --------------------------------------------------------------- ---------------------------------------------------------- -----------I------- ------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with-SaAn-joaquin County <br /> ordinances, State laws, and rules and,regulations of the San Joaquin Local Health District. <br /> _t�/ 4: <br /> 2 <br /> .(Pwner and4o <br /> __jSigned)---- ----------------------- ------------------ ---- --- -----------------I------ ------------------------------- ------------------- ----------- <br /> t 7 1 _r.Contractor <br /> )_ <br /> ---- ----------- <br /> By=------ - ----------------- --------------------- ---------------------------------------------------i----- <br /> -- <br /> ___ <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 ---------------------------- ----------------------- ------ DATE-------- V--------------- -- <br /> REVIEWEDBY--------------------------t---------------—------'_'_------------------------------------------------------------DATE----- ------ - ------------------/---------------------- <br /> BUILDING PERMIT ISSUED--------------------------------------- <br /> -------------------------------------------------------------- DATE------------------------------------------------------------- <br /> -------------------------------------------------- -------------•--•------ ­-------- --------------------- ------- <br /> Alterations and/or recommej?dations:--------------------- �---------------- <br /> oe� <br /> caN�X��---------------------------------I-------------------------------- <br /> ------------------ ----------- ---------- _ .:cH------ <br /> -----------------------------__---------------------------------------------- ........ - --------------------------------------------------------- --------------------------------------- <br /> ------------------- -------- ..................... - ------------ ----------- --------------------------------- ---------- ----------------------------------------------------------- ------- <br /> -- - ------- ---- ---- <br /> -------------------- ----------- -- ---------------------- <br /> -- -- ------------ -----------------I- -- ---------- --------- ---------------------- <br /> ------------- -/. <br /> ------------------------------ <br /> FINAL INSPE Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 RIEViSrO 5-59 3M 3-'63 P-P.C[3. <br />