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k. <br /> APPLICATION FOR ,. NITATION PERMIT <br /> .5 y 3 I5 . (Complete in Duplicate) SI / <br /> 1 � rel .. .� 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 /> ,jo"'his application is made in compliance �ith County Opiace' No H499.JOB ADDRESS ANQ CAT ON.., -- --�"1.--------- ---- <br /> Owner's Name---------- ----- - - _. Phone._ ---------..--- <br /> Address ----------• --------------•-------------•---------__"- <br /> --- - -- ----- -- <br /> Contractor's Name----- -_---------------lie'-"------:r ----------------------------------.----------------------•--------------- <br /> Installation <br /> -------- •--Installation will serve: Residence R• Apartment House ❑ Commercial [I Trailer Court ❑ Motet ❑ Other ❑ �sY <br /> A <br /> -Number of living units: __i___:_fNumber of bedrooms`_._ Number of baths':_j____ Lot size __]"��_'_ _."""_-"-_"--_-____"-""""_ <br /> Water Supply: Public system &community system [3Private ❑ 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: Yes ❑ No New Construction: Yes B­�No ❑ <br /> TYPE OF INSTALLATIOWAND-SPEC IFICATIONS <br /> i ` <br /> #s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r <br /> " Se tic Tank: Distance from nearest well-____.__._______Distance from foundation_____________-._-.Material------------------------------------------------- <br /> Ul.� No. of compartments--------------------------Size------•-------------------------Liquid depth----------------- ------.-Capacity----------------------- <br /> Disposal Fiel Distance from nearest well----------- -----Distance from foundation___"-______"..._.-".Distance to nearest lot line.__...___._.____. <br /> Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------" <br /> Type of filter material-"--- -------------------Depth of filter material"."..___". "_._Total length------------------------------------------ <br /> Seep <br /> -."""_"""""_""-""_-"""_"__---- __""_...Seepag Pit: Distance�to nearest -..Distance from foundation----��tan4e�to nearest lot line <br /> Number of pits.."---I!........-------Lining mate ria LJ�J..Size: Diameter__.._.:_. Depth_____y ""i'--- <br /> 1—C, <br /> ,.:.Cesspool: Distance from nearest well----------------- from foundation---.,._...----------Lining material--.------------------------------------ <br /> ( ❑ Size:-Diameter--------------------------------------Depth-:--------------------------- ------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well__------ ----------------------------_----------Distance ffom nearest building------------------------- <br /> ---------------- <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------ --- <br /> j6Remodeling and/or repairing (describe):------- -u----k-- _--------------------- <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 /> k ordinances, S+ate laws, and,rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ----- ----------•-•------------------------------ -------------------------------------------"-------.------ ------------(Owner and/or Contracto <br /> r ey----------- ! v. (r+le} <br /> (Plot plan, showing siz lot, location of system in relation to wells, buildings, etc., can be placed on reverse sine} � <br /> FOR DEPARTMENT USE ONLY <br /> s - <br /> ' APPLICATION ACCEPTE� BY------- ___________________•._-- - -------------------------------- DATEL-1/-G 7 <br /> REVIEWEDBY---------------------------------- -------I---------------------------------- -----------------------------------------------DATE---------------- _ <br /> BUILDINGPERMIT.ISSUED----------------------------------------------------------------------------------------------------- DATE.----._-"._."------------------------ ---------- ----- <br /> Alterations and/or recommendations------- ----------- ---- - ----- ------------------------------------- <br /> �� T 9 �€� ``�' '�` - _... �..- .; ---�--- ---- -- - ---- .... <br /> x ----- --------- <br /> 4K ` �lr '� `1�-'I�,- ..�r '•., ----- ---- • ----- •-- -- <br /> --„ .�''atr'' A.� ' ----------- --•-------• --------- <br /> --- - •- - <br /> 6 �� A-�� rw� c_: ? r* " �"� ''°``' X61 °ala:_ ,t ��r i.E �,a �z 'f�'l' ft------------ <br /> I ' * <br /> "FINAL INSPECTION BY:_____ _______________________ v' <br /> -------- -- • --------•- - Date.------�------------------------------ ------------------------- -•• -•--••--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Menteaa, California Tracy, California <br /> r <br /> ES--9 - 145446 Arw000 { <br />