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FOR OFFICE USE: <br /> ------------------ -__------7f.. APPLICATION` 'FOR-SARITATION-4-PERMIT Permit No. .�Ua <br />........ -----' <br /> - (Comple+e in Duplicate) <br /> This Permit Expires 1 Year From Date Isvied'"` Date Issued <br /> ii <br /> Application, is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance Nip. 549. <br /> ESS A LOCATION___ __.�_. . _ . _ �: r� <br /> ----- <br /> JOB ADESS <br /> /i. - ------- Phone t--- <br /> Owner's Name- -¢. - - <br /> - ------•-•------- <br /> t------•-- <br /> Name------------ -=----- -----•-- ---- ---- -----------------------• ------- ------------ --- Phone-.------------------------..----- <br /> Installation will serve: Residence AI r-11partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ ----- Number of bedrooms -. .. Number of baths_,_ Lot sizeQd Q•-- <br /> J -�__ --- -------------- s. <br /> Water 5u �I Public system Sup y ❑ Community system ❑ Pr:ivateA..r'Depfh to Water Table -/-4 ft <br /> Character of soil to a depth of 3 feet- SandGravel ❑ Sandy Loam ❑ Clay Loam Clay Adobe❑ Hardpan ❑ I <br /> Previous Application Made: (If yes,date_--------._, l No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi • Tan '� isfance from nearest well-----------------Distance from foundation-------------------Material ____..._-_...______-____. <br /> --------- ------------ <br /> Disposal Fief No. of compartments !_ Size-----•------------- - ---------Liquid depth---- ---- ------ ....... Capacity---- ------ <br /> r <br /> Distance from nearest well__- / <br /> �� �__._Distance from foundatio ___-_.6_._._--.Distance to nearest lot line..�______ <br /> Number of lines____--- Length of each line_-.._ Q__r__ Width of trench.. <br /> ------•-- G <br /> - -------- ---- <br /> �y <br /> "LQ ype of filter material-- C1 _ .._Depth of filter material___` ...........Total length------- _ _ ---------------- V <br /> �� o <br /> Seepage,Pity Distance to nearest-well_.___..._._.---------Distance from foundation--------------------Distance to nearest lot line___--_-__..____..- <br /> ❑ Number of pats--- -----------------Lining materiaE---------------- ----- Size: Diameter--- <br /> -------------- ----Depth--------------------------------- <br /> Cesspool: <br /> -----_--------- _--Cesspool: Distance from nearest well ---------------Distance from foundation_________________ _ Lining material--------- ------------___--_____ - <br /> ❑ Size: Diameter_ __ _________ ____ <br /> ----Depth--- -- ----------------- --- - ---------------Liquid Capacity. -----------------------..gals. <br /> Privy: Distance from nearest well------------ __------------------------___------Distance from nearest building....._-_---------------------- - <br /> ❑ r Distance to nearest lot line--------------------- -- --- - ---------- -- -- ----------------- ------=--------- •--- <br /> Rem delin Land/or repairing (describe):------. -- - <br /> --.-- --------- ._ <br /> - - • <br /> ------------------------- <br /> ------------ ------•-- ---- -- <br /> ---------- ------------ --------------------- •--------------•- -- <br /> ---------------____11-------------- <br /> y' certify that I have prepared this application and that the work will be done:in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District-' <br /> [Signed} G� ----- ----- and/or caner Contra t <br /> .. - <br /> or <br /> ------- -----Y. <br /> - - -------- ---- <br /> - {Title}(Plot Plan,, sawing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)., <br /> i <br /> �I FO DEPARTMENT USE ONLY ff <br /> APPLICATION <br /> = -------------------------------------------------------------- <br /> �N ACCEPTED BY ._ DATE-- ------ ------�- ----------- - <br /> REVIEWED BY --------- - - - <br /> - -- - ---- -------- - ----------- ----------------------- -------• BATE-------------Alterations anl'BUILDING <br /> d/aERMIT ISSUED - ------------r - DATEF­­-- --------------- - -- -- <br /> nd/ rec mmendat' ns:..., r ------------ <br /> - ----- -- <br /> :. <br /> FINALINSPECTION BY:------ ---------- - -- ---------------------------------- --- .Date--------------------- --------- --------------------------------------- <br /> 1601 <br /> - <br /> l SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 16011 E.kaielton Ave. 300 West Oak Street 124 SycaR.�-s rtf3t 205 West 91h Street t <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.H.9 2M 1-67 Vanguafd Press <br /> �-_�•._- °-III '�`I4-�- Y � - -_ .�.. rte. �� - - _Y_ � �� Y�- •-"'.'�� �, <br />