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FOR OFFIU USE. <br /> ------- - -----101_;ZZ�---------- APPLICATION FOANITATION PERMIT Permit No. J.;.Z-.'z <br /> _]�v----------------------------------- .... Cl/ <br /> --------------- ----------- ----------------------------- (Complete in Duplicate) <br /> --------------------­­------------------ -------------- - This Permit Expires 1 Year From Date Issued 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 /> JOB ADDRESS AND LOCATION....._.3.19_.A_d.amore---D.rAv_e..__-St.k1..n..................................................................................... <br /> ................ ............ ..... .... ... <br /> Owner's Name............................Lavern and Jo 21aine Smida <br /> ........................................................................................................................ Phone---Aqt....�-248 Off. <br /> Address....................................... ._31.0...A4a..mo...r....e....D...r...i..ve. <br /> ....S..tk...n.................................................. G..r...... <br /> .............. . ..... <br /> ......... <br /> Contractor's Name....................Delta_.Agptja Tank Serviceit <br /> - ----------------------------------------- ...Ino_.___________ _._. Phone. HO. .-n <br /> Installation will serve: Residence [;g Apartment House E] Commercial F] Trailer Court [] Motel ❑ Other ❑ <br /> Number of living units: _--.1. Number of bedrooms .3_--- Number of baths ..?... Lot size .... ............................. <br /> Water Supply: Public system El Community system [I Private [Z Depth to Water Table .5.0.- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam E] Clay Loam 0 Clay ❑ Adobe[3: H6rdpan ❑ <br /> Previous Application Made: (if yes,date--------------- No F9 New Construction: Yes [I No 0 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 /> Septic Tank: Distance from nearest well...5Q-1-------Distance from foundation.......1.0........MatIrial----- -_-------------- <br /> cm No. of compartments..........Z--------------Size------4.1....x---4........Liquid depth__.... . ._:.._._-_-._Capacity .4d............ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line_....._..._...... <br /> Exiting Number of lines-----------------------------------Length of each line..............................Width of trench..._....____...._.._..--.._......... <br /> Type of filter material.________________________Depth of filter material-----------------------Total length.......................------ <br /> ............ <br /> A DePAO---monr---to <br /> Seepage Pit: Distance to nearest well-----$5..Number of pits..........I---------Lining material....rQqk_------Size: Diameter......Distance from founclation-.1.0.........Di§bnce t9 nearest lot lineA <br /> ..ROXO <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material...................................... <br /> El Size: Diameter-------- ----------------------------Depth----------------------------------------------------Liquid Capacity............................gals.. <br /> Privy: Distance from nearest well..................................._-..._......_Distance from nearest building............._..._..._......_..._.......-. <br /> 0 Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------.................. <br /> Remodeling and/or repairing (d jibe):- --- - - - ggpjq.-..tank------to--*-r----e--place-----existing_ septi, <br /> taak; Irwatalling rieW .ert a _drol,t- a-_to 8APP1 %nt--existin—--drain — f i---iisDon- <br /> 8lb-11-11Y---f ---dratn.. <br /> _r;0% owner-I.A--well----I.@...assumed--by...the...... <br /> Qvner-v---Lave rn- -an-d-Zo---Elaine..ftlda............................................I--------------------------------------------------------------........------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun#y <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-----------D elta._S Ap tIC---- ----------------------------------------------------------(Owner and/or Contractor) <br /> By:-------P!$LrU..9.._WAX!th ..............................................................................(rifle)........qj!p_j....Ngr,--------­------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..... ...4 ------ ----- ---------- -------------------------------------------- DATE------------5.7­1'�141111li---- --------_----------- <br /> ------- -------------- <br /> REVIEWED BY-------........................ ----ra!�_ ----------------------------------------------------- DATE............................................................ <br /> BUILDINGPERMIT ISSUED..................................................................................................... DATE............................................................. <br /> Alterationsand/or recommendations:..............X-------------------------------------------------------------------------------*------------------­*­-------------------------------------- <br /> ..... .... <br /> 0-------------------------- . .....•-•----•-•-•----•- ----- -------,_...•----.._..---------------- ... .............................................................. <br /> --------------­---- <br /> _------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------- <br /> ------------------------------------ ------- ---------­---­------ ................................................................................................................................................... <br /> r— — � 0 - <br /> FINAL INSPECTION BY:.-e Date---------9:��l-------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Es-9 RrVIMED 8.59 F.F.Ca.am 6-60 <br />