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��FPR OFFICE USE. t <br /> 7------------!K - <br /> o0PLICATION FOA i31TATIPERMITPermit No. .. 1-l.r�. <br /> 6- ----------------�� -------------- S ,. ON <br /> ---��� � �-- (Complete in Duplicate) Date 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 Or finance No. 549. <br /> JOB ADDRESS AND CATION_____ °Z <br /> --------------- -- ------------------------------------------------------------------------------------------------------------------------------ <br /> Owner's Name ---- � �---- ---- Phone <br /> - - <br /> 0FP <br /> Address---------- 6 <br /> Contractor's Name---- ------- -- --------•----_------ ---------------------------- --------------------------------------------------------- Phone-------------------------------•-- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --1-_-_ Number of bedrooms J---_ Number of baths -I_-_ Lot size ___Ia- __X_J_1.7_________________________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table __44—ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ N <br /> Previous Application Made: (If yes,dat 7 ) No New Construction: Yes 2"''No E] FHA/VA: Yes RT— No E]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 fo4datign---/0------------Material.---- ---------- ---- <br /> No. of compartments_._._2.----- --_.Size______ .. X_Q.Liquid depth___-'¢_�----- --------Capacity _ <br /> Disposal Field: Distance from nearest well-_-- -----_._Distance from foundation-_-- ......Distance to nearest lot line_-_ <br /> Number of lines--------- _._. Length of each line_-.-�c�+.---_-._-_-_.--Width of trench._.-� _,_ ._._._.________ <br /> k <br /> Type of filter material-_`..�_ � -----_Depth of filter material----- g <br /> ---------Total length ------------------------------- <br /> Seepage Pit: Distance to nearest well--__--------------Distance from foundation-----(k--_____-...Distance to nearest lot line_-.45_-_-.._._. <br /> [ ' Number of pits.-___;�-------- -_.Lining material---RO_C- --_ Size: Diameter---_33. ........Depth------------X_cr_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------------- _Lining material_----- .--_---_--.-__-__---_-. <br /> ❑ Size: Diameter--- -------------- --------------Depth--------------- -- -------------- ----------------Liquid Capacity-------------- -------------gals. <br /> Privy: Distance from nearest well -------------- --- --Distance from nearest building----- __----------_._____-.-_-_-__--.-. <br /> ❑ Distance to nearest lot line.- --- ------------------------ -------- ------------------------ --------------------- -------------------------------------------- <br /> Remodeling and/or repairing (describe)----------------------------------------------------------------------------------•-------------------------------------------------••---------------- <br /> ----------I-----•--•--------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------- ------------ <br /> ------------------ ---------------- ------- -----------------------------------------------------------------------------------•-------------------------------•------------•---------------------------------- <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, and rules noregu tions of the San Joaquin Local Health District. <br /> (Signed)--------------------------------' -_ --. ----------------------------- ------------- ------------- -------------------------------------(Owner and/or Contractor) <br /> BY:------------------------------------------------------------------------------------- --------------------------------------------(Title)---------------- -------------- - ---- ------------- <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 /> '� � <br /> APPLICATION ACCEPTED BY-----------------�---------------------------------------- <br /> --------- ------ DATE------ ----------------------- <br /> ' <br /> REVIEWEDBY---------------------------------------------- ----------- ----- --------------------------------------------------------- DATE-------------- ----------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------ ------------------------------------------ ------------------------ --------- DATE------------- --------- ------------------------------------- <br /> Al+era on and/or re end tions: ------------------------------..-..-------------------------------------------------------------------------------------------------------------- <br /> s _ 'a ------- --- / ----- ---------------------- -------; <br /> '----------------•-----•---•--------��.... <br /> ------ <br /> - ----------- ----------------- -------------------------- <br /> FINAL <br /> --- --------------------FINAL INSPECTION BY: -- -------------------------- - Date-------- /� - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CC. <br />