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FOR OF� USE: <br /> J�6 ---------- '.L <br /> ..._..-✓'_ .____.�/._q-------------- - --- APPLICATION FOR SAWATION PERMIT Permit No. ..�-�.. <br /> -- <br /> ------ --------- -- <br /> --- --------- ------- ---------------- -= -- - (Complete in Duplicate) <br /> DIssued ssue <br /> Date f� S�/� <br /> - <br /> .-.__. f <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 compliant with County Ordinance No. 549. <br /> t e <br /> JOB ADDRESS ANDpLOCATION. ------44 <br /> ........... <br /> -------------------- ------------------------- -------- --- <br /> Owner's Name -----• - ��------ ----------------------•---------------------- --- - - - - ---------- Phone------------------------------------ <br /> Address-------- -- •--- ---- - - ----------- •---------------------------------------------•-------•------------•---------------•-••-•••----•--------............--•-•- <br /> Contractor's Name.. _0• -•=-••---------------------------------�---- '------- ----•-=---­ ..-_....> Phone-----...---------...........----- <br /> a <br /> Installation will serve: Residence [3"-Apartment House ❑ Commercial ❑ Trailer Cdurt ❑ Motel ❑ Other ❑ <br /> Number of livingunits: .`�.--- Number of bedrooms _-3__ Number of baths _ * � � � <br /> _....;.Cot size ---••---'- ---x------' -------------- - <br /> Water Supply: Public system ❑ Community system �rivate ❑ Depth To Water Table �r_.... ft. <br /> Character of soil to a de th of 3 feet: Sand Gravel Sand Loam Cla Loam Clay Adobe , ,/Hardpan <br /> p ❑ ❑ Y ❑ Y: ❑ Y ❑ L`I ❑ <br /> Previous Application,Made: (If yes,date------- ---.--.---.) No ET'— New Construction: Yes ff"'No ❑ FHA/VA: Yes [T"' No ❑ <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_&_. .:-------- <br /> MateriaL_.%a- 4'Di��'f <br /> ®' f No. of compartments------,�-------------Size_,3x6__. _?_ ---------Liquid depth-----------------------Capacity__k0V. - <br /> Disposal Field: Distance from nearest well__~ -.-----Distance from foundation./j0-------------.Distance to nearest lot line. _--_v__..... <br /> Ur Number of lines----- -_-.--- `---------Length of J9Wlintel"T f 1--".e Width of trench.------ ----------------- - <br /> Type of filter material. __�__C_�_-.-----Depth of filter material--_/ ---------------Total length-A25!" ------------7------------ <br /> Seepage <br /> .••-----------••--•- <br /> Seepage Pit: Distance to nearest well ---.----- -_:_Distancerom foundation- _._._--.Distance to nearest lot line.47�._..---. <br /> IV Number of pits-------- Lining (mate ria l___-_°�l._&,_C_<------ Diameter-%-473........ --,Depth-----—ZJ...-------------- <br /> Cesspool: Distance from nearest we'll --'-------------Distance from foundation--------------------Lining material------------------------------....... ' <br /> ❑ S. iz: Diameter----------------------------------=----Depth----------------------------;-----------=----------Liquid Capacity--------------------••-----•gals. ' <br /> Privy: ' Dis <br /> tance from nearest well----------------------------------------- --.-Distance from nearest building <br /> - <br /> ❑ . i. .Distance to nearest lot line ------ <br /> . <br /> Remodeling ancf/or repairing (describe):--------------------------------- --_ ----------------------- -- <br /> - , -- ------------------- ---- <br /> ------------E- r ---------------------------------------------------------------- <br /> - ----------------------- ­--------------------I-- ----------------------•---------------------------------------------•--•----------------------------------------••------•----------------------------------- <br /> A#,4L -hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> o dinances, State laws, and rules and regulations the n Joaquin Local Health District. <br /> •s��2 <br /> (Signed)ned-------------------------------•----- ....... ------ -------- ------'----- --------------•----- --------------`- <br /> -----------••-----------...(Owner and/or Contracfor) <br /> i . . <br /> I <br /> By:--------------------------------------------- -- ----- ------------------------------ -----------------------------(Title).------------------------------- ---=--- -- ---- -------------- <br /> (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed'on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- <br /> ' - DATE---�= �4 —7-.----- ---- <br /> REVIEWEDBY z:-!?'----------------•--------------------------------------------------------------------- ------ DATE----------------•---•-••-- <br /> BUILDING PERMIT ISSUED...-------------------------------------•-------------_---------------------------------- <br /> ----------- DATE----------------------------------------------- <br /> Alterationst <br /> and/or recommendations:__-" �% f•. rix_ __ <br /> -•............. <br /> ' . -------- <br /> ----------------------------------------------------- <br /> ! <br /> ----- - ------- -- <br /> =--------------... ----�----- ...--- , '��`'``y ah.:._c� r.- rI f-v-z��---t_ <br /> ---- <br /> -- --------- <br /> ----------- <br /> -------------- <br /> - - _ ��--L:�- . �X�-mfr - ...._` "�. ^1-----!----'F�G----mac-- '�-�-•-• --------- <br /> ----------------------------- <br /> ----- <br /> --- ---------- -- • - - ---- <br /> ------------- <br /> FINAL INSPECTION BY_- /�.-.l_ ... Date lry <br /> x SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Weil 9th street <br /> J Stockton,California Lod],California Manteca,California Tracy,California <br /> Es 9 REVISED 8-59 2M 5-62 ATLAS <br />