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FOR OFFICE USE: -- <br /> =a . .................. <br /> -------------- ---------------------------- ----------- APPLICATION F0F!tSAiVf CATION PERMIT Permit No. . <br /> -- --- ---- ----------- - -------------------------- (Complete-in Duplicate) <br /> --- ----- -pP--- ---- - ------- ------ -- -"--- --- This Permit Expires l Year From Date Issued Date issued <br /> A lication 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 />{ I <br /> JOB ADDRESS AND LOCATION---------- <br /> W-- <br /> _ ---------- <br /> Owner's Name 1� -L---6W .. ---- <br /> ----- -. Phone----------Address----------57-a --------------- •----•-- <br /> _. <br /> Contractor's Name--,!_ 'r • �/.... /--: Phony <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` <br /> Number of living units: J-._ Number of bedrooms _ol� Number of baths J__-- Lot size ,-2- -, O <br /> Water Supply: ❑ X.-- <br /> Public system � Community system �] Private Depth to Water Table ______ _ ft �) <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes date__._..____ ------ <br /> - 1 No ❑ New Construction: Yes J 'f No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: V1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wefl.................Distance from foundation___.__.'-` -----------Mate iaf _. -_------_-".- .-. <br /> ,� if/..,/; ---- ------------ <br /> I ►S �b1o. of compar#ments__._ --------------Size. __ �__-----Li uid de th__._� . ��� <br /> 1 12 e - q p. , Com --.....-Capacity.--- <br /> Disposal Field: Distance from nearest well..___'--_-._.Distance from foundation_--._`_._..Z_-A_I}i a cue-to nearest lot line__—_---..---_. <br /> Number of lines--------- ............. .. �Len of each line_.-- --�Q-- ---.--_-Width of trench.____ <br /> Type of filter materia` <br /> � _---_ ep of filter material----/T-----------Total length------------------ -/------------- <br /> Seepage Pit: Distance to nearest well-------__________-----Distance from f un ti n----------_—...Distance to nearest io line----of pits.._ �_--....__._lining materia ize: iameter__ �j �� " <br /> - ..- .---Dept -- ----------------- <br /> Cesspool: Distance from nearest well -------_------Distance from foundation_.................Lining material- <br /> El .___----------___-.--_-_--- <br /> ------- <br /> Size: Diameter - Depth ---------------------Liquid Capacity------------------------- <br /> __gals, , <br /> Privy: Distance from nearest well----------___------- __---_...._Distance from nearest building <br /> ❑ Distance to nearest lot fine-------.--------.........-------_ ' <br /> ----------------------------- <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 laws, and rules and regulations of the'San Joaquin Local Health District. <br /> (Signed--------------- -------- <br /> ............ <br /> - ---.- ----- -- ------------ -----.----- _(Owner and/or Contractor) <br /> 8Y� ----- <br /> --------------- ---'--------------- Title <br /> (Plof 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 /> APPLICATION ACCEPTED BY---'77Y� C/-------------------- ----._ DATE <br /> REVIEWEDBY---- ------------------------------ ----------------------------- ------- DATE . <br /> -- - -- --- - --------------- <br /> BUILDING PERMIT ISSUED-------- -- ------------------------------ <br /> - --------- -- ---- ----- ------------------ - DATE--- �--------- -- ----- - <br /> Alterations and/or recommendations:_-____----------- _ <br /> --------------------------- <br /> FINAL INSPECTION BY:._ V ,7 ----=- Date.. `� = _.`_�_..45 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street <br /> 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press r.?.d a <br />