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FOR OFFICE USE: <br /> -------------------------------- ---------- ------- <br /> 11 <br /> ---------I------------------------ --------------------- APPIIATION FOR SMITATION PERMIT Permit No. <br /> ------------------------------I-------------------------- (Complete in Duplicate) SCA"%'A[EAate Issued <br /> --------------------------------- -------------------- This Permit Expires I 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. CA13#1V 6KOVP <br /> JOB ADDRESS AND. LOCAT(IA/JIeJF----- -50-----A-1-3-PAIK"r------ ---- ------------1"'rc A . <br /> WAX-----47 ­----------------- <br /> Owner's Name--------------V t t:?_rz.i_N__1.A-----------CAtnaRx---------------------- - ---------------------------- ------------- Phone------------------------------------- <br /> Address......................... --------Bo_*<----------136----�..........AMN E�Oq------------------........................................ <br /> Contractor's Name------e.wJ_N.F—_%----------------------------------------------------------­­----- -------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House [j Commercial E] Trailer Court E] Motel [] Other 01VA 61 N <br /> Number of living units: -t----- Number of bedrooms I___.-- Number of baths t_-__-_ Lot size ----- -----51------- <br /> -- --------------- <br /> Water Supply: Public system E] Community system K."Private E] Depth to Water Table 12-5—ft. <br /> Character of soil to a depth of 3 feet: Sand ErGravel E] Sandy Loam [-] Clay Loam E] Clay [-] Adobe[] Hardpan <br /> Previous Application Made: (if yes,date__-_______-____-) No,ff-_'New Construction: Yes Prqo E] FHA/VA: Yes [E-] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . <br /> Sepfic, k: Distance from nearest well_-_ Distance from foundation-----IC--------MaferiaL---< R-ETF........ <br /> No. of compartments-_2----------------- ...Liquid clepth------ Capacity--- <br /> Disposal Field: Distance from nearest well__/04?-----Distance from foundation---JO---------Distance to nearest lot line_- <br /> Number of lines.-----/-------------------------Length of each line-----go---- Width of trench--------2 it ji, I % <br /> 14r----- ------- I..____R..____._. <br /> -- ------- <br /> Type of filter materialiR_0_a��------Depth of filter material--- /_9...........Total length________________ - ----­----------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_--__---__-'___--_ <br /> ❑ <br /> ine----------------- <br /> F1 Number of pits__--_--.-_-_______Lining material---------- ---------_-Size: Diameter---------__ --------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-______--.-__-__-_.--____________-. <br /> ❑ <br /> aterial-------------------------------------- <br /> 0 Size: Diameter----- --------------- ----------------Depth------------ ----------------- --------- -------Liquid Capacity- --------------------------gals <br /> Privy: Distance from nearest well--------------------------------------------.- .-Distance from nearest building---------------------------------- ------ <br /> RDistance to nearest lot line----------------------------------------- --------------------------------------------------------------------------------------_ ----- <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ -------------------------------------------------------- <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 Ipws, and rules a d I fi <br /> ;T requ a iQns of the San Joaquin Local Health District. <br /> (Signed) --------------------------------------------------------------- ---------------------(Owner and/or Contractor) <br /> By:-------------------------------------------------------------_---------------------------------------------------------------------(Title)------------------------------- ------------- - - ---- ----------k <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------T.R.-O---------------------------------------------------------V------- DATE-----AP' 7 16s-------------------------- <br /> REVIEWEDBY-------------------------------------------------------------------------- ---_------------------ --------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------- ------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------I-----­-­-------------------------------------------- --- ---------- ---------------------------- ----- - ------- --- ---------------------------------------------------------_----1-----l----.1--.1--.-..-.-.-.------------------------------------------------­--­------------------------------------------------------------- <br /> - <br /> ---------------------I----------------------------------- ------------ ----I--------- -------------------------------------------------------­----- ---------- --------------- -------------------------- ....... <br /> ---------------------- ------------------- -------­---------------- ------------------------------------------------------------­­------------------------------------------------------------------------------ <br /> nn <br /> FINAL INSPEC Date-------------- <br /> ---------- --- -------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.00. <br />