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b _ <br /> APPLICATION FO NITATION PERMIT Permit No. _.. -_ ... <br /> (Complete in Duplicate) / <br /> 1�/` Date Issued .. /.,3/.­ <br /> A <br /> . <br /> Applica+ion 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 /> 2363 <br /> JOB ADDRESS AND LOCATION. ••--- ---- ----- _ <br /> Owner's Name.-------------------------------------------- . --------------------------------------- --------------------------- ------ Phone--if "- ....... <br /> Contractor's NameD, ______________ _-..__.__- Phone. 3--3",( 4­0 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ A�ptel ❑ Other ❑ <br /> Number of living units: .__ Number of bedrooms -_z-. Number of baths Lot size -----.$_Q R_ 1 F'q............................. <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table4_�_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No 2r' New Construction: Yes E3"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-_____-_-______-.-_.Material-----------_-_..-_-_-.-.-___..__-_____--.-__.._.. <br /> No. of compartments_-- ---------Size---------------'------ . -Liqu h-----•- ---------------Capacity.... <br /> Disp�d: Distance from nearest well -.------------Distance from foundation_ ____ _-_ Distance to nearest lot.lm __Aa.-__- <br /> Number of lines-----------------------------------Length of each line------------------------------Width of french.................. ---- --_ <br /> Type of filter material_____ _ ______--------Depth of filter material___-._ ____ �_ otal length.......................... <br /> Seepagjw,Pit: Distance to nearest weIL. G_iJ---�-----Distanc from foundatiof._..Distarce to nearest Igt J�nser <br /> __ ...... <br /> Number of pits__ ________________Lining material_ Size: Diameter.....13-_-.-_-_-____Depth__.__-_.__J____-__--"-"_":-_ - <br /> Cesspool: Distance from nearest well________________•Distance from foundation--------------------Lining material._....-------------------_._.._....._. GV <br /> ❑ Sizer Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity--------------- .......gals. Q <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------..................... <br /> ❑ Distance to nearest lot line- <br /> ---------------------------------------•-••-------------------------------------------•-----------------•-------------------•----'--------- <br /> Remodeling and/or repairing (describe):_-- 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, State laws, and rules and regulations-of the San Joaquin Local Health District. <br /> (Signed)--- -- ---..... ••-- ...�• ---------'•---''-•---------------------------------------------------------------------------- ...........(Owner and/or Contractor) <br /> -------------------------- <br /> By:------------- --- ------•---- .............................................................(Ti <br /> '!""� - ' <br /> (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be placed on reverse( de). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B - ----- -------------•----------------------------------- DATE.-ZZ---------------------------- <br /> BY....................----- . - ­-----------­-------- -------•-' DATE.__. <br /> -- <br /> BUILDINGPERMIT I$SUED.................................... .. •--•'-•-------------'-•------- ------ DATE........W................................................. <br /> Alter fi d/or recogendations t__ , <br /> r .�w <br /> ��1=-�•-- ----•-- �----7�� :...__--��•=_.._-•--- - --..�.�•3,,..t�` .�=,ra«�..'M.,�.�.�':F�"'.��a'=""'"•�- --�.SZw2E' {-•.............�..: .r <br /> n <br /> •----•----------------•--•----•--•---------------------•----...---.....-- ---------------------------------- <br /> .....•--•-----•-••-•-•-----'-----•---•--•----.._._........................•---...--•-------------..._......---•-............-•-•-•......-•--._....--••------•----------._.........---...._................................ <br /> 111 <br /> f <br /> FINAL INSPECTION BY:.- f Y% ' . ,°�-.zol .y Date. /- G� `--'` v <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />