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0�1 APPLICATION FOR —ANITATION PERMIT Permit No. .#!_57_:1 _...3._ <br /> (Complete in Duplicate) i; 3 7 <br /> Date Issued ---.I_`�jS----1- <br /> m <br /> pplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> his application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------1-0---IA---- ----' ,!J n,�'-,t' <br /> --------------------- ---- <br /> --------- -------- <br /> Owners Name-- u. .....&-4------ •- '�r` ,; - 1. <br /> Address---------- ..........------------- <br /> Contractor's Name-_-.4�. f-- ... Phone�bFQ.- 3- J.. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo)e) Other ❑ ' J <br /> Number of living units: ___1-_ Number of bedrooms,;;.--- Number of baths .--I--_ Lot size __- - _--_^- _________________________•_ <br /> Water Supply: Public system (�C.ommunity system E] Private E] Depth to Water Table -_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam - Clay Loam ❑ Clay El Adobe Hardpan E]Previous Application Made: Yes L] No F2 New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,r <br /> Septic Tank: Distance from nearest well--,--------------Distance from foundation--------------------Material------------------------------------------------- <br /> qjuNo. of compartments--------------------- ---Size--------------------------.- Liquid depth--------------------------Capacity----------------------- <br /> Disposal Fi Id: Distance from nearest well--------- -----Distance from foundation-----------------_Distance to nearest lot line---------------- i <br /> f— Number of lines----------------- ---- - -!------Length of each line----------. ---.-----------.-.Width of trench------------------------------------ <br /> Type or filter ma- Depth''+"r __------Depth of filter material---.. Total length---------- ----------------_--_---_.-..- <br /> SeePit: Distance to nearest well_.( s?--" '.....Distance from foundation------ -----------Distance to nearest lot Ii -------------- \ <br /> Number of pits.-..-------------_Lining matenal� --------Size:,Diameter------_-.----..........Deptn__-------_-,).---__ ... _:: <br /> Cesspool: Distance from nearest well------------------Distance from foundation-------------------.Lining material-------------------------------------- <br /> ❑ Size: Diameter--- ------------- - - ----------------Depfh----------------------------------------------------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well.------------------------------------------------Distance from nearest building-------------.--------_--_-_--.----_-----. �l{ <br /> ❑ Distance to nearest lot line-------------------------------- -_ ' <br /> Remodeling and/or repairing (describe):------ .--- - :- -- -- ad. ----_-. .:-c�xt -----••-------•---- <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 /> ,r � ..°---------------------------------------- ---------- <br /> (Signed) -------Owner and/or Contractor <br /> -- ( / <br /> 1 <br /> BY:------------ ------ ------ +-.�1--------------------------- ------------------------------------ {Title) G -'---------- -------------- <br /> (Plot plan, showing sizot, location of system in relation to wells, buildings, etc., can be placed on revers side). ✓ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY�----------- ------------------------------------- -------------------------------------------- DATE —----------------- ------ <br /> REVIEWEDBY------------------------------ _------------------------------------------ -----• DATE__._`t ---------- --------------------------•-.-.----- <br /> BUILDING PERMIT ISSUED----•---- -` ~-= DATE <br /> Alterations and/or.recommendations---------------- ------ -----------= --------------------------------------------------- '�---- <br /> - -- <br /> -- ----�Q ��c ---------------------------- <br /> -------- // - <br /> ----.- ) t/ <br /> -------------------------------------------- ----------------- ----- r_ 1 <br /> •.. _ <br /> FINAL INSPECTION BY:.... - r� <br /> -. <br /> SAN�jO,QUIN LOCAL HEALTH DISTR_IC J <br /> 130 South American Street 300 West Ck.Street __ .. w -�{3Y ycamor0frre of F 814 North "C" Street <br /> Stockton, California T Lodiv.C�4ornia Mafite_ca,"California Tracy, California <br /> ED.—S 145446 ATWOO❑ rte.. -77- <br /> _. V _ <br />