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FOR OFFICE USE: A -_ <br /> " ° "" ~ --------------- -- APPLICATION POR �SAN'IT-ATION PERMIT Permit No. _ •.. ..._..-. <br /> ------------------------ - --------------- -------- (Complete-in Duplicate) <br /> - --- This permit Expires I Year From Date Issued Date Issued .7-1 ..-p�, <br /> Application is hereby made to the San Joaquin Local Health District for a permit'to construct and install'thee 2ork he0re n descri ed. <br /> This application is inaderin_compliance with County Ordinance No. 549. SCA <br /> srAE <br /> �-�r------------------------------------l~Y � <br /> JOB ADDRESS AND LOCATION .............. � <br /> 11�1A.c .. <br /> Owner's Name - .S _e------------ <br /> -------- Phone--- ------------------- --•--•-- <br /> Address------------- <br /> 19-7 . 4 i - - c p LQN-- ---------- ---- ....... <br /> Contractor's Name -t/ W- ==----------I----------------- ------- -- ------------------------- - ------------•--- Phone.----------------- -------------- <br /> Installation <br /> ----- - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ._ .---- Number of bedrooms ._2. Number of baths _1 Lot size <br /> f -_- ------ _T ---___ , <br /> .-- . <br /> Water Supply: Public system ❑ Community system 0 Private ❑ Depth to ater Table ft <br /> Character of soil to a depth of 3 feet- Sand [] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe [:] Hardpan <br /> Previous Application Made: {If yes,date-----------------_ ) No New Construction: Yes E] No �HA/VA: Yes � No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br />--- (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) <br /> Septic�'Tank: Distance from nearest well--.---- ..Distance from foundation--------------------Mate r'al ...(QOAk R <br /> Lam' Capacity--..No. of compartments----. 7 -------_Size-.--YXJ0..X-'_ Liquid depth___ 8 <br /> = <br /> Disposal F' Id: Distance from nearest well.__-_-5 Distance from foundation---._.------1 ._-Distance to nearest lot line_... <br /> [ � Number of lines._.....-._ /.............._-------Length of each line-_ ......- - <br /> f 9 �n` Width of trench + ---- <br /> Type of filter material.. [} .......Depth of filter material------P 0 _Total length....................�p r <br /> Seepage Pit: Distance to clearest well-------100----Distance from foundation----------`.0_. Distance o nearest lot line-----_......_ <br /> .--.__Linin material-_ _ Q-0<,, Size: Diameter.-.__ -y... <br /> Numbar of pits.-- --- -_---- g Depth.... .�- <br /> -- - --------------- <br /> Cesspool: Distance from nearest well ---------------'Distance from foundation----------------- ..Lining material-..-------------._.__....._---- s <br /> ❑ Size: Diameter- .. ......... . <br /> -Depth--------- ------ ------------ ----------------Liquid Capacity----------------------------gals. _ <br /> Privy: Distance from nearest well------.------..............._-.__.____----------Distance from nearesf building � <br /> ❑ Distance to nearest lot line------- <br /> Remodeling <br /> -----Remodeling and/or repairing (describe):------Aaoc ------- - .L -•------------------•-------------------•-------- -------------------------------------------- <br /> -----•----------------•--•--------------- --------------- --•------------------------- - ------------------------------------------- --------------- --- --------------------- -------------------------- ----------------- ! <br /> ---------------------------------------------------------------•----------------•---------••---------------------------------------------------------------------------------------------------- # <br /> I here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfa a aws, and rules an egulations of the San Joaquin Local Health District. <br /> (Signed) (Owner and/or Contract <br /> 1 <br /> By:.--------------- --------------- --------------•-------------------------------------rl---.------------------- ­­---------- -(Title)---------- -------- <br /> (Plot plan;-showing size of•lot,-location-of-system-in relation fo wells, buildings, MI.can a placed on reverseside)��-- -- Q <br /> FOR DEPARTMENT USE ONLY T� <br /> APPLICATION ACCEPTED BY------- i- ©' DATE-... .."-/..- - i <br /> -------------------- -------------- <br /> REVIEWED BY --------------------------- ------------------------------ DATE..... <br /> BUILDING PERMIT ISSUED-------- -- --------------------- --------------------------------- -----------------------------... DATE----------------- ---- <br /> Alterations and/or recommendations:.------------------------- ------------------------- <br /> ------------ ----- --------- ----------------------- ---------- -------- ---------- - -------------------------- ---- .- -------- - --------------•--------------------------•-----•-------------•--------•-- <br /> t <br /> L — <br /> FINAL ! ----------- Date------ <br /> ' f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California i <br /> E.H.9 2M 1-67 Vanguard Press IF <br />