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FOR OFFICE USE: <br /> --------- '---A-cul---------- --------- <br /> __�_- r------- ------ APPLICATION FOVSANI'TATION :PERMIT Permit No. ...... .-.. <br /> �� � 3 -- �jyj---- (Complete in Duplicate) <br /> --.--- This Permit Ex fres 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per'rrlit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. f� / ,, l <br /> JOB ADDRESS AND LO ATION ----73J�_._6?-----c§ �-,� /-� (fit s77J Q/.l%l_ <br /> Owner's Name ------------- te_.. <br /> �r <br /> --- -- O <br /> Address ..... QX._.. f ---- -- <br /> -P_-A----F .__R.-_5_R---------I----s.CMs------ -------------- -- ��&pkP_7__._ <br /> Contractor's Name______.__ __ _ _____________________ Phone. __ __ <br /> Installation will serve: Residence '$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ! <br /> Number of living units: __/---- Number of bedrooms - _ Number of baths-L_--_ Lot size __ell__ __- ------- -_ __ ___ ___-_-_________---___ ' <br /> Water Supply: Public system ❑ Community system ❑ Private g Depth to Water Table ff,157 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------------------- ) No YL New Construction: Yes ❑ No)!�-_FHA/VA: Yes ❑ NoX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material -------------------------------.----------------- <br /> ❑AuS7fWC7 No. of compartments---------- ------ - - Size-------------_------ Liquid depth--------- --.-.-. ........Capacity <br /> Disposal Field: iDVumbeCeofolines ea st well-. Des ath of each I nndation-- a---------- to nearest lot <br /> -- g - i e__ 5--- ------ trench.-.—,,-., <br /> Total length-----.a_ ___FT-__-_-____r_ <br /> Seepage Pit: Distance_to'neare�s fwellje� _0-------- m `f' ndation_-!0______-_.Di ve to nearest to line-".!!S' <br /> Number,of pits.--L.� _� -------Lining material____-� .:Size: Diameter___- ._--- --_-Depth., ------------ ...... <br /> Cesspool: Distance from nearest well '____Distance from foundation-------- ..Lining material------------------------------------- <br /> El <br /> ------------- ----------------------❑ Size: Diameter- -------------- ---------f-----Depth----:-- ., ........................ ------------- Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well._j ""'----------------_...... ____---------Distance from nearest building_-__--____.____.-_____________.________ <br /> ❑+ Distance to nearest lot line____________ :------ ------_____._.__ <br /> ;,- cam[----------- ------------------------------ <br /> Remodeling and/or repairing a(describe):---------- ---- - -- -- =- ---- - -- - - ------ - ------- -------------•------------- �l,r <br /> -•------•----------------------------------------- ------------------------------------------------------------------•------------------------------------------------------------------ ---------------------------- <br /> ----------------------------------- <br /> � S} • }- ilk <br /> I hereby certifylfha ve prepared this application and that the work will be done in accordance with-San Joaquin County <br /> ordinances, State laws, in utas and reguI t' s of the San Joaq ' Local Health District. <br /> �r A' <br /> (Signed)----------------------- - (Owner and/or Contractor) <br /> BY:--------•-------•-- ; {Title) - i <br /> Piot plan, showing size of lot location of system in relation to wells buildings, etc., can belaceFonreverse ide. <br /> 3 ,FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- -------------- DATE- -Z-- -G- �--- ----------------- <br /> ---- <br /> ---- <br /> REVIEWEDBY------------------ ------------- -- - ------------:--- -- ---------- ------------- ------------------------------------ DATE------ ----- ' <br /> BUILDINGPERMIT ISSUED------------ ------------------------------------t---------------------------------------------------- DATE----------------------------------- ------------------------- <br /> Alterations and/or recommendations:- ........... ------- ------------------ ------------- --- ------------ ------- ----•-- --- ---------•------------------------- ---­ <br /> ---------------- <br /> - <br /> -------- -------------------- -_ -_--_- ---..-..-__-.-.-.-..._#---_----___-_-___-___--_----__-__________L`_____________--_--_-______-_-_--_______-..-_--____._--_-._______-. <br /> -------------------------- -------- ��---------------`-t-------------------------------------- -------------------------------------------------------- --------- ----- --------------------------- -------- <br /> -------------------------- -------------------------------- -- ---------- - ------------------------------------------------- <br /> - ----------------------------------------------------- <br /> - - - - - ------- ---- -- -- --- <br /> FINAL INSPECTION BY: <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1501 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Mantecar California Tracy, California <br /> E.K.9 2M 1-67 Vanguard Press <br />