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;✓ FOR OFFICE USE: <br /> =J, `f---------------------------------------- <br /> M ----__-----.___.-------.---:- - --------- APPLICATION FOR SANJTATION PERMIT Permit No. ..���..� <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 /> It <br /> JOB ADDRESS AND LOCATION-W- ,/ <br /> - 1> •�r�-----, f_ fi` -------------------------------------------- ------------------------------ <br /> Owner's Name...... ......�4-...... <br /> I_ -- ----- Phone--•--•------------------------------ <br /> Address _. _ _... ------------ ------------------------ ----------------------------------------.--- <br /> - �►--' <br /> Contractor's Name------ --xeOZ-p--•"- —il ;,7_.-�------------ - ------- -------------------------------------------•--- Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ .__._ Number of bedrooms ,oG--- Number of baths__._.._. Lot size 4607 <br /> Water Supply: Public system 001-community system E] Private ❑ Depth to Water Table,111570ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan p <br /> Previous Application Made: (If yes,date-------- ---------- ) No New Construction: Yes ❑ NoW?00'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-----.-----------Distance from foundation-------------------Material __________________.____.__-..__-_.______-.... <br /> ��Pf No. of compartments------------------------Size-------------------------------Ligi�Qepth--------- ------- - Capacity--------------------•-- <br /> U. <br /> Disposal Field: " Distance from nearest well_.._" '. _Distance from foundation____________________Distance to nearest lot line_t'�_ '-- <br /> If / Number of lines__.---_____-�__. __._____ Length of each line__ ---------Width of trench...2._____�.____-__..__.-____ <br /> Type of filter materiaj �,C e th of filter material____,.-,0,e. Total length__. ._s� ' V�- <br /> P -� <br /> Seepage Pit: Distance to nearest well------ --____Distance fr fou�ation__e�dP._.__..Distance to nearest lot line_4-_'__'-_- <br /> 0!2 002 Ar�/� Number of pits.---/------------Lining material` — ---- Size: Diameter_ ._.Depth__a�-t0--------------------- <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 or re pairing (describe):-_.__.._. _ _._____--_. / �/„le�" -- __ ______ <br /> G�a►a� 4 , <br /> ------- -- <br /> .� - <br /> ------------ <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------------------- �7e `` r - (��� Contractor) <br /> --------------------------------_...------•-----. ------ = - -----(Title)--- --------- <br /> By: <br /> (Plot plan, showing size of lot, location of syst relation to we rs, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION-ACCEPTED BY----------- -------- ---------I---- --------- ---- -- --------------------------------------- DATE---------�______� ~'�. . .------------------------- - <br /> REVIEWEDBY ----- ----------------•---------------------------------- <br /> - -------------------- DATE------ ------------------------------------------------ <br /> BUILDING PERMIT ISSUED------- ------ DATE------------------ ---------------------------- <br /> Alter oand/orrrec mmendations:-------------- - _-. . .. _------ --- -------------------------------------- <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 /> E.H.9 2M 1.67 Vanguard Press <br />