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L <br /> '0CATION FO <br /> —------- AF,' AWAMN PtOn Permit No. <br /> -------------------------------------------- ------------ (Complete in Duplicate) <br /> ------------------------- ------- ----- ----------------- This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor!V�q ein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> �6 . <br /> 4 <br /> JOB ADDRESS AND LOCATION_A551',WdC. <br /> Owner's Name------- <br /> -------------------- ------------------------------------ <br /> Phon - <br /> Address_... <br /> Contractor's Name_......... ----------- ---•-------•---------------------------------------------.... Pho e,r.. <br /> - -- ------------- <br /> Installation will serve: Residence El Apartment House E] Copmercial E] Trailer Court E]. Motel P. V> <br /> I Er <br /> Number of living units, Number of SeclreomKs/��_ 41ugber of baths ---!�',Lot size <br /> I <br /> Water Supply: Public system E] Comm u'nity system E] Private V-015epth to Water Table ft. <br /> Character of soil to a depth of 3 feelf: Salnd El Grav'eil El Sandy Loam F <br /> Clay Loar-6'­o Cla­yZro"Adobe- --H' <br /> 0 _ardpan C1 <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes Jg�lo E] FHA/VA; Yes E] No <br /> I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 0# <br /> Septic Tank: Distance from nearest well---J6�'-----Distance from,foqndafion__Ze---------MQ,L-.rial_erW6._Z/i <br /> nfs.... <br /> _A <br /> No. of comparfmllA------------ P� 4$------Capacity <br /> �;----Size-;?X-,/,?---6i!iik?"Uquid depth-_---A----V___ ---- <br /> Disposal Field: Distance from nearest wellZO-------Distance from foundafion__e! a _--_....Distance to nearest lot line------------ <br /> Number'of lines Length of each line-z/1010--`------------Width of french_,,�?-/------------- <br /> 50 <br /> Type of filter mate,i-a�l 44. Depth of filter material_ ----Tofal length-- _.--.--- <br /> Seepage Pit: <br /> Distance to nearest well-Ile"re ---Distance-fro <br /> Number of pits...IC7 --m fouadation---Z,447_ ,_:Distapce to nearest lot line-----—_ <br /> - ----------- -'Lining material._/_1*7,64_6.Size: Dia mete r- -------Deptk420--v��_ , <br /> 1 11 7 / —7 le <br /> Cesspool: Distance from nearest well____----_-___---Distance from foundation------------- �__.Linipq material---.----------------------- <br /> El Size: Diameter----- -------------------------------Depth----------------------------- ----------------------t Liqyi;d Capacity---------- _ ----------- <br /> I ----------------gals. <br /> Privy: Distance from nearest well--------------- --------------------------------Disfance from nearest building.._____--------_.-----_---._ <br /> gials <br /> a0 --------- ----- <br /> F1 Distance to nearest lot line--,.------------------------------ <br /> --------------- <br /> -- ------------- <br /> --------------------------- <br /> Remodeling an or repairing (describe):---------- A " <br /> - ------- ------------------------- <br /> ----------------------- --- ---------- <br /> ------------------- -----------------------------------I-----------...--------------------------------------- <br /> -----------------------•------------------------------------------------------------------------ ----------- <br /> --------------------------------------- <br /> ---------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that 1. have prepared this application and that the work will 6e done in accordance with San Joaquin County <br /> ordinances, State laws, and rules an regulations of f�e San Joaquin Local Health District. <br /> Ze ------ -----------------------------------------40*a&Lavul�=Contractor) <br /> (Signed}-------•---------- <br /> By:----------------------------------------------I <br /> d' <br /> regulations <br /> ---------- ------------ -------------- <br /> --- ---------- ----_- --.-_--- <br /> ( plan, showing size of lot, location' of system ation +a wells, buildings, efc.,' can be p6c�en <br /> Y-V , d on reverse side). <br /> Fok.-bEPARTMENT USE ONLY <br /> T 0 <br /> APPLICATION ACCEPTED BY----------- <br /> --- ---- -------------------------------------- DATE-- e>11 e,5 <br /> r y ----------I------------------- <br /> ------------ <br /> REVIEWED BY---- ----------------------------------I---------------- ---------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED-------------------__-_- ----------- DATE._--.----. <br /> Alk------------------------ <br /> - ---�f---------------------------------------------- --------- <br /> Alterations and/or recornmend4fions. ----------- ------------------------- <br /> ------ ------ ...... <br /> L------------------ -- -- ---- -------f ---------r- <br /> ----------- ------------ <br /> ----------- <br /> -C <br /> ----------- ------------A----------- -----------------------;�----------------------- ----------- <br /> ----------------------------------- --------------------- ---------------------- -------------------------- -------------------- ------------------------- ------------------------ --- -------------- <br /> ------------------ --------------- ----------__-------- <br /> ----------------- - --- ----------------------- ------------------ -------------------------------- -- ------------------ -------- ---------------------------- <br /> FINAL INSPECTION BY:_ ----- ---------- Date. -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.111oxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California. Manteca,California Tracy,California <br /> F.P.Co. <br />