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�_, ,Z_� <br /> FOR OFFICE USE: / <br /> Permit No. . - <br /> " / r �------- s� APPLICATION <br /> "" �AOR SANITAT10�f PERMIT <br /> U Com lete in Duplicate) V�14_1 <br /> -------------------- { P P ) Data Issued ----- <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 compliance with County Ordinance No. 549. <br /> A <br /> 4_ J --------------------•--...---• <br /> r <br /> JOB ADDRESSAND LOTION__-%%� ` "--- <br /> Phone------------------------------ <br /> Owner's Name--------- -- *i <br /> ------- <br /> Address......... <br /> --•--Address-----•-•-JS4 � � -------- ---- <br /> Phone- -------�� <br /> Contractor's Name------------ 0—a-1114.1 <br /> — - -. ----- ¢ --------•------------------------ <br /> � <br /> 11 <br /> Installation will serve: Residence F1 Apartment House [IGomrnarcia.l ❑ Traile ,,,❑ , Motel ❑ Other <br /> ®h ' X-`r° -------------------- f <br /> Number of living units: -------- Number of bedrooms --------lNumber of baths o2, .. Lot size -----�__-_-- <br /> 1 t Depth to Water Table __-____ fta, <br /> Water Supply: Public system.[7J�ommunity system ❑ Private ❑ p <br /> Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay El Adobe Hardpan 11 <br /> Previous Application Made: (if yes,date------------- -- -y No ❑ New Construction: Yes 93-<o ElFFiA/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 /> � ,t s t. <br /> �- p,� 0--------.Material__�t_ ___ ------- <br /> Septic T k: Distance from nearest well___ Di t ante f,Pm fo�dation._-1_ r�l �Odew. <br /> No. of compartments--------- `-"__ _-"-"-Size54 -X----- "-Liqu1d depth---•-�G�-------------CapacEty_�Disposal Field: Distance from nearest wel Distance from foundation__,l_4__�___.___Distance to neatest lot line__._____.. <br /> Number of lines--------- I -Length of each line___yQ"------- -------Width of.trench".____��"---_-____-_--- --""-- <br /> YP . .. i-« �: D'eptW of filter material-----/ ----�-----Total length.. ��p f (l� <br /> I See a e Pit: DEstance to nearest e "D ___----.Distance to Barest lot line___-Q"_"-- "\ <br /> T e of filter materia_ <br /> Linin Ce f ndation___. _ �P <br /> P g ll_ Y om__--Distan, Size: Diameter------ -49�.3_Depth----- - �--------------- <br /> .fr oma#erial <br /> Number of pits_____--- . �. <br />: ...s#ante from foundation-__________________Lining material-------------------------------------- <br /> -------- <br /> ___---____-______.______:___--___ <br /> Cesspool Distance <br /> Diameter nearer wel!__ "'� 'Depth --------Liquid Capacity----------•-----•-----------gals. <br /> ❑ t <br /> Privy: Distance from nearest`well--------------------________' <br /> ----------------------Distance from nearest building------------------ -----•-----------"----- <br /> ❑ Distance to nearest lot line-------- k -------------------- ---------------------•• <br /> *y � <br /> �-- - c <br /> Remodeling and/or repairing describe :__. _ fes ?�•,------• � ------ 4' ""`" <br />' g � P 9 � ) �- -- --- � I <br /> -------•----------------=---- ----------- ------------------------•-------------- #------------------------------------- <br /> ------------- -------------------- <br /> ------ --- --- -- - ---- -------------------------------------------------•---------------------------------- --------------- = <br /> 1 hereby certify that I have prepared this application and;that the work will be done in accordance with San Joaquin County <br /> ordinances, St laws nd rulesIregulatigns f thVSa J,loaquin Local Health District. <br /> • - - ----------------- 0 (Owner and/or Contractor] <br /> (Title)------ <br /> (Plot plan, showing size of lot, location of system in relafion to ells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY l �i <br /> 00 <br /> --- - ------------------------ <br /> --------------- DATE_. --=�� <br /> APPLICATION ACCEPTED BY---- �- - �'-- -- •-�-'^& --------------------------------- <br /> DATE <br /> -------------------------- ---- <br /> �t <br /> REVIEWED BY------------------------------- ----------------------------------------------------------------- DATE------------ ----------------------------------­------- <br /> REVIEWED <br /> PERMITISSUED----------------------------•------------•-------------------•---------------------- DATE <br /> ___________________________4__._________-___-_______.______-____________ <br /> ---- <br /> Altera#ions and/or recommendations:-------.__.-- • <br /> ------ ----------------------------- <br /> �`` <br /> -- <br /> --- <br /> ... <br /> -(� �' ' <br /> t� --------- ----- <br /> 1___________________________ <br /> ------------------------------------. <br /> ----- '�----r- <br /> --�-�--(p,• -----------------------•------ •---------- <br /> FINAL INSPECTION BY:_6I- � .-l�rtl'. e - <br /> --- <br /> --_ Date <br /> 1 SAN JOAQUIN LOCAL :HEALTH DISTRICT <br /> 130 South American Street <br /> 300 West Oak Street 124 Sycamore Street 205 west 9th Street <br /> I Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 BEVIErD 8.59 r.P.CO.2M 6.60 <br /> L -- <br />