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y� <br />A <br />APPLICATION m Duplicate) <br />FOR ll ION PERMIT �' Permit No _ � U-__�2 5-- <br />mplete <br />t <br />• <br />f3ge Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install rk herein described. <br />This application is made in compliance with County Ordinance No. 549. j <br />JOB ADDRESS AND LOCATIO _ zPh------ <br />,�- <br />V.Owner's Name t -..` <br />Address-------- 4 -------------------- -- -- - = j <br />Contractors Name ----------- -- ---- �- PhonA_' .. <br />Installation will serve: Residence Apartment House ❑ Commercial ❑ .Trai�Of 4 ourt ❑ K*el ❑ <br />Number of living units: __ Number of bedrooms 7--. Number of baths '_, Lit size ---------- _Arv. -------------------- <br />Water <br />_______ _________Water Supply: Public system J Community system ❑ Private ❑Depth to Wafsable #` <br />Character of soil to a depth of 3 feet: Sand Gravel E]` Sandy Loam [ Qlayam Qt elay,[ Ado hardpan ❑ w, <br />Previous Application Made: Yes E]No New Construction: Yes ❑ No iIAN,,A.. Yes ❑ N <br />TYPE OF INSTALLATION AND SPECIFICATIONS: s' <br />(No septic tank or'cesspool permitted if public sewer is available within 200 feefj '<-- <br />eptic w Distance from nearest well Distance from foundation _____._ f Material�4'apacity <br />:_ <br />No. of compartments_____ - _-__ _ ___Size _________ _______ Liquid bepth.---------- ----, <br />Die o a i d: Dista a , <br />p Distance from nearest well Distance from foundation {sf f"hearest lot hne N,' <br />Number of lines ------------ ----- Length of each line-------------------------Widf ' :.nearest <br />-- --- --_--- <br />Type of filter material_____ _ _ _ _________ Depth of filter material----------------------- Total length ------------------------------------ <br />S ee <br />___-____________________-______See a e Pit: Distance to nearest eIL __ 1I���_Distance '.foundation__ � r -'__.Distanpq to nearest lot lme <br />Number of pits--- -l_.-- - ---- Lining material -----/k.6 - C.Size: Diameter---,, ------- Depth_ ---------------- <br />Cesspool: Distance from nearest well----------------- Distance from foundation Linirig'material ------ ------ _------------------------ <br />Size: <br />_ ____-__-____ _____Size: Diameter -------------------------------------- Depth.---------- - ------ ------Liquid, Capacity- --- ' ......... gals. <br />Priv Distance fromnearest well ___ Ds-tance from nearest building __ <br />❑ Distance to nearest lot line ---------------------- ------------ ---------------------------------------------- ----------- <br />Remodeling <br />--- --Remodeling and/or repairing (describe):, _ ____ _____ _ _________ ^____ _..... ... .__.._t__ <br />------------------- ------------------- -- ---------- -- - ------------ - - <br />• --- ' -------1 <br />--------------------------------------------------- ---- — _----•--------------------------------------------------------- �------------------------------------------------------------ -------------- ------------------ <br />I <br />----- ----- Y <br />I herebycertifythat I have re ared this a plication and a w will be done in accordance with San Joaquin Count <br />ordinances, State laws, and rules and regula+i f + S Jo n Loc .;j�kealth District. <br />Signed ----- C��'✓� wne nd ar ntrector <br />( 9 ) l -- -- - - / ) <br />Plot Ian, showing size of lot, location of s st i .relation --- - " -- --------------------- '__(Title) ---- <br />By: ......... <br />( p g y to wells, bui Ings, etc., can be placed on reverse side). <br />FOR. DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY -- -- - --- �----------------------- •DATE - !`------- E� <br />REVIEWEDBY -------------------------------------- ------------------------.1 -- ----- -------------- -- -- --- DATE -------------......................... <br />BUILDING PERMIT ISSUED ------------------------------------------ <br />--- -- -- • --------- ___--------------------- DATE---------------- ----------- . . <br />Alteratio;w and/ort recommendations--- -------------- -- --_- -- <br />------- ------ - ------ -----•------------ . <br />w:. <br />... ' mss- --__ -- ----- ----�-.--- <br />-.-- - <br />----------------------------------------------- - -- - ------------­------------ --------- -- -- <br />en <br />r <br />FM"AL INSPECTIONkBY:-'-0---- - ---- --------- -- ..i; avec -----At <br />SAN JOAQUIN L HEALTH DIS RICT " <br />s k:. <br />130 South American Street 300 West Oak Street 132 „$ycajnors Street &F# lifoctf+ "" Suis+ <br />Stockton, California Lodi, California Mant*ce, California : ` �4racy tii orniahk <br />/ <br />ES -9-2 M Revised t-57�.P.00. t� <br />- <br />:yt <br />s 4 . { <br />