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FOR OFFICE USE: 1 <br /> f <br /> ------------------ <br /> I----- APPLICATION- FOR-SAW IITATION PERMIT Permit No. . ._. ........... <br /> ------- ------------------------------------------ ---- (Complete in Duplicate) <br /> ------------------ ---------------------------------- .__- This Permit Expires 1 Year From Date Issued Date Issued __ <br /> Application is hereby madeiito the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. 20 0(—rq0_07 <br /> �� <br /> JOB ADDRESS AND LOCATION__..__. c { <br /> Owner's Name. 'jq <br /> .`y--R—k---------- W- _F-r-----a R-------------•-- --------------------- ------------------ ------------------ Phone------------------------------------ <br /> Address----____---_-----------.�D -------kk.SPN-----�D--------(4oK•-------k_3--� g AN_ iCa1�7Y21�_ UIEt� + u[1, Rl s�.HC <br /> Contractor's Name--------------111------------------S..i[.c.Jw�----------------------- ---------- Phone__S3:�-,-_5gM----- <br /> lnstallatidp will serve: Residence ❑ Apartment House ❑ Commercial [�' Trailer Court ❑ Motel ❑ ther E]t9'3 <br /> Number of living - _ <br /> units: -------- Number of bedrooms _______. Number of baths _____ Lot size _____-_.____�_______ _ ______________________________ <br /> Water Supply: Public <br /> system ❑ Community system ❑ Private Ea'-Depth to Water Table _lam_ ft. <br /> Character of soil to a depth- of 3,feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam [:] Clay El Adobe ®`Hardpan ❑ <br /> Previous Application Made:' I(If yes,dote--------- -------) No E5�­ New Construction: Yes 2�No ❑ FHANA: Yes ❑ No ET'_ <br /> TYPE OF INSTALLATION ND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: jo(r Distant efroni nearest well--r`1 --------Distance from foundation----t <br /> Material_____�n2 ________No, of m artments_.._._ a_____________Size______ -x-Q> �------Liqu3d depth-- -----�� ----- CapacitY---- -p UCID <br /> � <br /> Disposal Field: Distancel,from nearest well_-.49-------Distance from foundati0 -_-_I0________-Distance to nearest lot <br /> Numbers of lines---------- ------------ -- ------Length of each line-------- �.---------------Width of trench.-___-- -.`----------------------- <br /> IType of;filter material-50eTlZ-.1�KDepth of filter material____1-8-----------Total length-----------�--_______________________ <br /> Seepage Pit: Distance'to nearest well----------------------Distance from foundation__________________ Distance to nearest lot line-__________--__ <br /> ❑ Numbers of pits----------------------Lining material _- <br /> ---------Size: Diameter.------------ ---------Deptn--------------------------------- <br /> Cesspool: <br /> ---------------- -- ------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material _._._____________-_____.------------ <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------- -------- -- ---Liquid Capacity gals. <br /> ----------- <br /> 4,- - _� _._ _ _.. _—.,,�.- __ -_.�_.s.��__�.�_�---��-,.-T•---. -,rte. --�----�-_ w_ .•„�_ <br /> I Privy: Distance from nearest we11_______________ ________________-_-__Distance from nearest building---______________._____________ ----_ <br /> 1 ❑ Distancelito nearest lot line--------- --------------------- ------------------------------------- <br /> I <br /> Remodelingand/or repairing (describe)-------- ------------ ------------------------------------------------------------•------------------------------------------------------------------- <br /> 11: <br /> --------------- ----------------------------------------------------I------------------------------------------------------------------------------------------- ----------------- ---- <br /> i ------------------------------------------------I---------------------•-- <br /> ------------------------------------------------ ---------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- <br /> 1ii 7 <br /> I hereby certify that Ihave 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 Joaquin Local Health District. <br /> i <br /> _. ��' <br /> (Signed)_ "^ ------------(Owner and/or Contractor) <br /> BY --------------•---------------------------------------- - ------------------------------------(Title)-------- -------- -- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR EP RTMENT USE ONLY <br /> �r <br /> APPLICATION ACC EPTE Y------- ---------- ------------------- ---------------------------------------- DATE----------- --------�- <br /> REVIEWED BY---- -------- -- ----=1I,- ------------- DATE <br /> ------------------- --------------------------------------------------------- -------------------------------------------------- <br /> BUILDING PERMIT ISSU <br /> -"----------- -- - -------------------------------------------- - -------------------------------- DATE-------- --------------------- ---- - ------------------- <br /> Alterations and/or recommendations:--------------------- ------ ---------------------------------------------------------- -------------------------------------•- <br /> �' <br /> ---------- -------- -----------------------------11---------------- -------- <br /> ----- <br /> ---------------- - - <br /> ` -- <br /> I I� - <br /> F1NAL INSPECTIO Date-------- ---------------------------------------------- <br /> JO IN LOCAL HEALTH DISTRICT I <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Lodi, California Manteca,California <br /> Stockton,California Tracy,California <br /> R <br /> F.` C O. + <br /> I`III � e i <br /> II' <br />