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rVK Urri�, <br /> ------------(�----- -------------- -_:------- APPLICATION F10"RISANITAT16W PERMIT Permit No. .....3. ....73 <br /> ..... <br />----------------------------------------------- ------- (Complete in Duplicate) Date Issued <br /> ---------------------------------- ----------------- This Permit Expires 1 Year From Date Issued <br /> 04t — 270-3S7 <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-com Iliance with.County-Ordinance No.-549.--- <br /> 4 - 74 <br /> -----&------A- <br /> --W------V---- <br /> ..JOB ADDRESS AND LOCATION.--- - <br /> Owner's NamA... _ -L,.....A1 _........ -_------- .-.-.-.-.-.-.-.-.-.-.-.-.-.-.- <br /> ................ --------­----- ........ <br /> Address.-..----Ft_01 4_zl:.� <br /> ------- -------- .................. --------------------- <br /> Qj. ...................... ------------------------ <br /> Contractor's Name.----------- <br /> ire- - - -- - --- ---------- --------- ...........--- Phone.W. <br /> Installation will serve: Residence' W-partment House 0 Commercial C] Trailer Court ❑ <br /> Motel El Other <br /> Number of living units: Number of bedroom's __V_ Number of bath size <br /> Water Supply: Pu_blk­system [Community system ❑ Private Depth to Water Table 7P. ft. <br /> Gravel [-] Sandy Loam ❑ Clay Loam gr1clay 0 Adobe[] Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand [_ y I <br /> Previous Application Made: (if yes,date-------- -----------) t No New Construction: Yes El No �H4/VA: Yes [3 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee <br /> jr nCe_fro._j� <br /> Septic V Dista M OU <br /> _>nk: Distance from nearest well- - ------ ndation---I!q----------Material-----------------­- <br /> ly No. of compartments-----3----------------- Liquid clepth___AO?t� ----Capacity. _s:�!;�-------- <br /> Disposal field: Distance from nearest well.,5____!Distancef`Z�M' founclation...Z.4t...........Distance to nearest lot linek <br /> Number of lines..........a---- lLenO�rof­each line_!4?0-------�,O-------Width of french_-_._' ... <br /> Type of filter maferial..45A44�---)Depth of filter mate1rial___,/9-----------Total-�l�__h -------------- <br /> eng[f <br /> ---------------------------- <br /> Seepage Pit: Distance to nearest well____--______- .-'---Distance from foundation-------------- stance to nearest iTt linef <br /> F-1 Number of pits-----------•---------Lining material-----------------------Size: Diameters----------------------Depth-----------------I----------- <br /> -- - -------------- <br /> Cesspool: Distance from nearest well---------- ------Distance from foundation-------------- -L.Lining material...........-----------: ........ <br /> ❑ <br /> Size: Diameter--------------------------------------Depth-------- ------------L-Liquid Capacity--------------------i--------gals. <br /> Privy: Distance from nearest well__________________________ <br /> --------------------Distance-'from nearest building------------ <br /> --I <br /> --------------•------------•- <br /> ❑ Distance to nearest lot line ° _ <br /> ------------ ------1!------- <br /> Remodeling and/or repairing (describe)_____________________ ------------------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------­------------------------------------I[-------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> =....-_.:--•----•------------------------ <br /> ------------------------------------------------------------------------------------------- ----------I----------------------------------------------I---------------_­ ,� f1----...------ <br /> ----*--------- <br /> --------- ------------- <br /> I hereby certify that I have pr ared this application andftat-the work will,-b-a�-done-in-aci:6rdafto—wit'h'S_anUoaquin County <br /> 11 ry rules <br /> -g, e laws, and rules n regulations the:San aquin Local Health District---, <br /> ordirtance <br /> n. <br /> (Signed)---- <br /> VI/ <br /> �v......11----------- - - ----------------- ----------94--t---- ------- -- -------------- ------------------------------- and or Contractorl <br /> By:-------_---------------__-------- <br /> ­--------------- - ------------ <br /> - --------------- .... ---------- <br /> (Plot plan, showing size ela oil$ <br /> Of lot, location of system in r - -------- --------- <br /> , buildings, etc. an be placed on reverie side)" <br /> FOR DEPARTMENT USE ONLY'� <br /> APPLICATION ACCEPTED BY.-- '_ ----------- DATE__ ------- <br /> ------ ---- <br /> ------------ ---- <br /> .... ----------- DA <br /> REVIEWED BY-------------- <br /> -------------- -------- ---------------- DATE-------•---------- -------- <br /> BUILDING PERMIT ISWED—...............m__ ------------------ ; <br /> Alterations and/or recortm >crations:--------- ------------------------------------ DATE----------------------g---------------------L------------- <br /> en I— <br /> ................................... --------------I-----------------------------------------------------------------------------------------------------------------------------------------------.......... ........ <br /> ---------------------- ------------------------------------------------------I-------------------------------------------­----------------------------------------------------------- <br /> T <br /> ------------------------------------...------------.........--••--- ­---------------------------------------------------------------------------------------- -------------- <br /> .............................................--------------------- ------------------------------------------------------------------------------------------------------------------------------ .............. <br /> ---------- <br /> FINAL INSPECTION BY:.. <br /> Date----- _.-. ... <br /> S <br /> ate-----S N JOAQUIN LOC, <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> StocklOnr California Lodi,California <br /> Manteca,California Tracy,California <br /> ES 9 REVISEO 8-99 2M 8-61 At AS <br />