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AvAvo <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 Qrdi �YNo. 549. <br />o. 5 <br />Ordin an, , Z9 <br />- ------------------------------------------------------------------------------------ -------------- <br />JOB ADDRESS AND LO TI <br />----------- -------- <br />---------- Phone_ ------------- <br />---- ------ ... <br />Owner's Name -------- .... .. <br />- ------------------------------------------------------ ---------------------------------------- ------------------------ <br />Address--•------- - -- ----------­---- --- <br />J�Z <br />Contractor's Nam6 -------------- ----------- - . -- --- - ------------------------------------ ­ --------------------------------------------- <br />Installation will serve: Residence & ApartmentCCommercial . House El Gbirnmercial Fj Trailer Court El Motel [I Other E] <br />------------------------------ <br />Number of living units: Number of bedrooms Lot size --- Number of baths / <br />Water Supply: Public system EZ Community system El Private 0 Depth fo Water Table -------- ft. <br />3 feet:\Sand [] Gravel 0 Sandy <br />Character of soil to a depth of 3 Loam Clay Loan; [] Clay El Adobe 0 Hardpan C] <br />Previous Application Made: YeslEj No fi(__New_Construction-._Y-es-[A No XL -FHA-/VA:-Y6-S- C--No-j< <br />TYPE OF INSTALLATION ANDI-SPECIF16A IONS: <br />(No septic tank or cesspoc?l per m&ted if public sewer is available within 100 fiet.) <br />---- <br />Septic T Distance from nearest well_____-_______.__ Distance from foundation ------------- - Material_______:_________-.-_____._.___-__----.---_.___. <br />\ Ia p a C -5f 71- - <br />No.. of com/parfrnents ------------------------ __ Size --------------- ---------------- Liquia depth ------------------------ _C ------ ------------ <br />Disposal 'F;,i­eId: Distance from nearest well.__---___-.__-_- Distance fro -m foundafio/n"4 ------------------ Distance to nearest' lot line__________--____. <br />Nur&'r of lines ------ 1 ---------------------------- Le'ngth of each line ----------------------------.Width of trench. _J.- ------------------ <br />1__D_ i i---length___________________________________'_._----------- <br />Type o� filter material-____ Depth of filter material Notal) <br />------------ <br />�tance FfafcAndation ---- 70 ----- stangip to nearest ce • <br />to nearest �well _'Di I line -i-19 ------- <br />Seepage P;,t: 0,Distan 'S <br />Numbe% of pits -------- ------------Lining material---- izelDiameter --- ----------- Depfh___> ------------------- <br />-------- <br />Cesspool: }Disfance from nearest well ------------------ Di�tance from foundation ----- ____-.Lining material___-____ <br />El=1e. Diameter --------- ---------------------------- D�pf h -------------------------------- ------------------- Liquid Capacity- - ------------------------ gals. <br />Privy: .-I ce from nearest well-------------- ------ I t.building -------- zc� --- - ------------------ : --------- <br />D 5tan e ------------------------- - D*stanLe from <br />f <br />❑Distance <br />nearest'lot line -------------f--------------------------•---------'-----•----- ----------- L ------------ = ------ ---------------- <br />-- -------- <br />Remodeling and repairing (cle'scr;Dj ----- I ------------ I -------------------------------- --------------------------------------- _.1 -------------------- ---------- <br />- ------ -------------------------------------------------- ----------- <br />---------------•----•------------------------------------ ------------------- --- - ------------------- <br />--------------_----------- j i� ------------------------------ <br />--------------------------------------- ------------------------------------------ ----- ---- ---------------------------------------------------------------- -- <br />i , i �`\, I ­ ----------------------- j ---- , I-- <br />--- - --- ---- - --- ---------- -- -------- :� ---------------------------------------- <br />- -- ---------------------- ----------------------------------- - - ----- I , __r- <br />' 1 application and that the work will 6� done in accordance with Sa�n Joaquin County <br />I h6re6y certify thlat I have prepar6d thi <br />ordinances, State laws,j I I ti�'. 1 <br />'7d)rules and regu a ions7the San Joaquin Local Health District. <br />v <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />This Permit Expires I.,,Year From Date Issued <br />Permit No. <br />Date Issued <br />(Signed) ------------------------ VV_ ---- -------- <br />-------- ------------ <br />A--ill --------- ------------------ <br />Ze, 0 1 location m <br />(Plot plan, showing si 'c' tion o system in kplafiomf"ells, bui <br />(Owner and/or Contractor) <br />(Title)..... ------------------ ---- --- ................... <br />Idings, etc can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY" <br />ED B <br />APPLICATION ACCEPTED BY ------- ------- -------- - I -- ------- ------------------------------------ DATE 61t ----------------------- <br />Y i ! DATE -------- - -Ja] <br />REVIEWEDBY --------------- I ----------------------------- I - ---- ------- - ---------------- --------- ------------------------------- <br />BUILDING PERMIT ISSUED-------------------- -- I ------------- - ----------- ...... _ -------------------------- ---------- DATE---------- ---- ----------------------------------------- -- <br />4 PERMIT <br />I - . f - ---- ----------- <br />Alterations and/or recokmendations: ------ ! ----------------------- ---- ----•-----------------------------------f~=--._...-------- <br />--------- -- -- -- - -- -------------------•-----•----------•-------------- <br />( <br />- ----- -- -- --- ---- ------------------------------- <br />---------------------------- -------------- ------------------ ----------- r- ----------------------------------- <br />----------------------------- <br />fi `I ' <br />-------------------- ----------- _­ ­ -.-- I I <br />-- --------- <br />------------------------------- <br />- - ------------ ------------------------ <br />- 14 1 ------------------------------------- ------ --- --------------- ­ ----------- <br />+ ------------------- - ---- ----- I- -- --------------------- <br />----------- -------- ------------------------------- <br />------------- --- --- ------- -------- - ---- ----- ------------------------- ---------- <br />4 1ItL i I <br />rV _ ------------------------------ -- -------------- <br />--- e <br />----------- ------ <br />FINAL INSPECTION BY----------- ------------- -------------- -- ---- - -- --- ---- <br />C - S -AN -JOAQUlN-LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES -9-2M Re4ised 9.'59 F.P.Co, <br />