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FOR OFFICE USE: <br />--- ------- --------------------------------- --------- PERMIT Permit No. <br /> APPLICATION FOR ANITATION <br />----------------------------- ------------------------- <br /> ----- --------- (Complete in Duplicate) Date issued ... <br /> --------------------------- <br />------- ------------ This Permit Expires I Year From Date Issue <br /> ibed. <br /> --------------- ---------------------- <br /> 11 the work herein descr <br /> r!�'s ru t�an i'nsta <br /> Application is hereby made to the San Joaquin Local Health District for a permit to c <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION ------- Phonq�/......�Ink <br /> -------------------------------* <br /> Owner s Name____/44_-ZA'ar <br /> 4tO-r <br /> Address-----. -_--------------- ... .................. 4 <br /> Contractor's Name-?_14M*�_------------------------------------------------------------------------------------------------------------- ---- Phone----------------------------------- <br /> Installation will serve: Residence 0 Apartment House 0 Commercial C] Trailer Court 0 motel 0 other 0 <br /> Number of living units: ._-.(__- Number of bedrooms -_--------- Number of baths -1------ Lot size ---- ----------------------------------- <br /> Water Supply: Public system (53 Community system 0 Private 0 Depth to Water Table -------- ft. <br /> Character of soil to a depth o4.3 feet: Sand F-j Gravel 0 Sandy Loam� Clay Loam R1 Clay 0 Adobe 0 Hardpan 0 <br /> Previous Application Made: (If yes,date________________---) No New Construction: Yes � NoO FHA/VA-. Yes C] NoEl <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> or cesspool permitted if public sewer is available within 200 feet <br /> (No septic tank I ateria,--- ................X­ <br /> Septic T.ank- Distance from nearest wil�0"f-----Distance from foundation--- M <br /> 'L -5-------Liquid-,cl�p.th...... ---------Capacity_.�.;��R:!?..�..... <br /> No. of compartments------e------------------ <br /> rest well-S-P.........Distance from foundation-'.l .........Distance to nearest lot line.,_�......... <br /> Disposal Field: Distance from nearest 0----------- ----Width of trench.-- -------•---- ---------- -----Length of each line. <br /> Number of lines ---- -- 474" �-J_r•-------------- <br /> Type of filter ma -----Depth of filter material--- - Total length-. - - <br /> -I <br /> Seepage Pit: Distance to nearest from foundation--------------------Distance to nearest lot line--..._-_____...._ <br /> .Zell-----------------------Distance ---------------------Depth.-------------------------------- <br /> Number of pits------:---------------Lining material--------- ------------Size: biometer__. <br /> i t -Lining material_------------------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation� <br /> -i -----*'--..Depth----------------------------------------------------Liquid Capacity---------------------------gals. <br /> , <br /> El Size: Diameter------ <br /> Distance from nearest <br /> .-Distance from nearest building______ _...___.____....____.__.._..___ .. <br /> Privy- t well_--_--_-------------------------- <br /> 0 Distance to nearest lot line----------------------------------------------------------------------- ----------------------------------••------------------- <br /> ............. -------- <br /> Remodeling and/or repairing [describe)--------------------=------•------------------•------------------------------------------------.. ........ <br /> ----------------------------------------------------------------- -------------------------------------------------------------------------- -------------------------------- <br /> ................................... ...............I---------------- <br /> -----------------------------------------------:��--------- -----------I--------------------------------------------------------------------------------------------------------I---------------------------------------- -- <br /> ------------------------- <br /> ----------I---------------­------------­­­­------------------ ----------------------------------­---------------- <br /> ---------------------------------- d.this application and that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared <br /> ordinances, State laws, and rules a d regulations of the San Joaquin Local Health District. <br /> (Signs - ------•-----------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> 4 _ ........... --------- ---------------(Title)----------------------------------------r----------------------- <br /> ................ <br /> ------------------­-------------------­--------- ) <br /> (Plot plan, showing size of lotjocation'.;f system in relation to wells, buildings, etc., can be placed on reverse side) <br /> FOR DEPARTMENT USE ONLY <br /> ------- 01 <br /> ... DATE___A_"._Z_ ------------------------------- <br /> APPLICATION ACCEPTED BY. <br /> -------------- DATE---------------------------------------------------------- <br /> REVIEWEDBY-------------------------------------- ---------------------------------------- DATE--------------------------------------------------------- <br /> ----------------------------- ---—---------------- <br /> BUILDING PERMIT ISSUED---------------------------- ------------------ ----------------------------------------- ---------..---------- <br /> Alterations and/or recommencrafions---- ----------- ---------------------------------------- ---I--------------------------m- <br /> ------ <br /> ------------------------------ <br /> ----------------------------------------------- --­----­----------------- --------------------------------------- ---------------------------------------------------------------------- <br /> ------------------:--------------------------------------------------------- --------------------------------------:---------------------------------------_----------------......................... <br /> -------------------- -------------­--------------------­----------- ------------------- <br /> ----------------------------------------- ---------------- -------------- <br /> -------------------- -------------- ----------------------- ...........I------------------------------------------------------- <br /> --------- ---------­­---------- ...... .........I-------------------------------- ------------------- <br /> FINAL INSPECTION BYX/jf----------- -------_............ <br /> Date_---207hr-42----------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Sy amore Street 205 West 9th Street <br /> 124 Sy <br /> 130 South American Street 300 West Oak Srreef I cc,California Tracy,California <br /> Lodi,California Monte <br /> Stockton,California <br /> ES 9 REVISED 8.59 2M 5-61 AILAB <br /> IT <br />