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FOR OFFICE USE: <br /> ---j�---------- <br /> /�63 y_p�---- :4. ...APPLICATION FOR SAN �ATI�N PERMIT Permit No./,------ r <br />- -------------------- -------------------------- (Complete in Duplicate) <br /> Date Isst. d _f- -�-45 <br /> . This Permit Expires 1 Year From 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 /> This application is made in complianc,� ith Count dinance No. 549. 1�# <br /> JOB ADDRESS AND L CAT ON__� 5- - ----------!"4--1 � i �'�''• = F <br /> Owner's Name---------r--�l-�-'��------�-���--�� _'------------------- -- ------------------------------- ---------------------------- Phone----------------- ------------------ <br /> Address--:;...... <br /> ----------------- <br /> Address-:....---� �--�------ ----- ----------------------------------- ---•-----------=-------------•-...-.------------------------------------...-----•-•- , <br /> Contractor's Name------ -------------_---------------------------------------------------------------- •-------- Phone--------------------------------- <br /> installation will serve:, Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / <br /> Number of Jiving units: __j_. Number of bedrooms ,3?-_ Number of'baths A---- Lot size ---- <br /> f <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _4? ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ t <br /> Previous Application Made: (if yes,date--------------------) No �ew Construction: Yes [y-r4o ❑ FHA/VA: Yes-p— No <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_Z�P___Distance from ffjQ�undatiop�_-fQ---__---__.Material__ _,r_��'- ----------- <br /> No. of compartments ._-___________...Sizer. liquid depth___' .____._...__.-Capacity�lf' -------- <br /> Disposal Field: Distance from nearest well/14P----- <br /> Distance.Jrom foundation l9___--_--..Distance to nearest lot line_-_-_------- <br /> [ � Number of lines-_----.��_...-{--�------- _Length of each lire_AAW-----4.2._. Width oftrench..�_-�A__.__--------------- <br /> r . <br /> Type of filter material /_Depth of filter material..______________Total length__�a` _-____._____._.__._______ W <br /> Seepage Pit: Distance to nearest well...O?e2249-----Distance from foundation-__f --------Distance to nearest lot lime___ _____________ <br /> p r �._._.-------Lining material__,&4Fc', -Size: Diameter-��-� :.....Depth .- � X <br /> Number of jts-� ._._ _ <br /> Cesspool: D•stance from nearest well------------- from foundation--------------- ----Lining , <br /> - Lim_ .-. <br /> aterial---. _-_.------_-_----. <br /> � <br /> ❑ Size: Diameter-1----------------- --------------I---Depth----------------------------F---- --------------_.Liquid Capacity----------------------------gals. <br /> I ..._.._-__-._..-Distance from nearest building.Privy: Distance from nearest well-------------�-�-------.-- -- � 9-------------------------------- ------ <br /> ❑ Distance to nearest lot line w - ----------- -------- <br /> ------ ----- -------- ------------------•-------------------- <br /> Remodeling and/or repairing (describe):---- - �''�- I <br /> t <br /> ------------------------------- --- -- ---- — I <br /> ----------------------------------------------------1­ - -------------------- -------•-----------•-----------------------------•-•-----•----------------------- --------------------------- --- ------------------ <br /> ------------------------- --- <br /> ----------------- <br /> - - ------ ----- - -------------- -----------------------T----------------------•---------------------------------------------------------------I---------------------------------------------- <br /> 1` 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 Joagtiih Local Health District. 1) <br /> " - ! --- --------------------------- -t...(Owner and/or Contractor) <br /> (Signed)-------- -------- <br /> B --- '" ----- -(Title) ---------- ---------------------- <br /> (Plot plan, showing.size of lot, location oftt,ystem in relaf o wells, buildings, etc., can be placed on reverse side). <br /> FOR 6EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY t - DATE ------------------ •- <br /> REVIEWEDBY -------------------------------------------- ------------ DATE <br /> BUILDING PERMIT ISSUED=------------------c j-- ------- f DATE-------------------------------- ------- - ------------ <br /> 1. r j <br /> ------------------------------------------------------------------------------ <br /> Alterations and/or recommendations 'f ---------- <br /> R <br /> t - Cep---- - x r te ° --- ----- <br /> -.- <br /> 1.6 <br /> ���. -. -• �.,.�.-T l r/a <br /> -------- _ ------ lam, o {�/ ---- A � <br /> si i�d 17, <br /> �/�fi ---- Date........ 9 fO G ------- ----- <br /> FINAL INSPECTION BY:.. - - -- -----------------------• ------._ �� --------------------------------- - {•� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT , <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Ilkt <br /> tstocklon,California Lodi,California Manteca,California Tracy,California <br /> ` <br /> f <br />