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Ask <br /> FOR OFFICE u <br /> ........ ............ 11. .... .......... ...... <br /> . ........................................... .. ...... <br /> .. <br /> APPLICATION FOR SAWATION PERMiT Permit No. <br /> .............................. ... ........ ... <br /> (Complete in Dup4caim) 17- <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 work hereir.4&&C"AW <br /> This application is made in compliants with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION— "z- o <br /> Owners Narria.—.&J04 ...... ...... ........ <br /> . .....) a4-...... ............. ... ............... ............. Phone <br /> Addr.L.__S~ <br /> Contractor's Name'_ ....... <br /> ..........I........... <br /> kW&U&tkm WA serve: Residence ❑ Apartment House 0 Commercial Trailer Court [3 Mojej ❑ other <br /> Number rO living units: ........ Number of bedrooms ... .... Number of baths <br /> Lot sue ........... <br /> Walter &*Plr' PUL4'c system C) Community System C1 Private - Depth to Water Table -.*. . . <br /> E;;r- S it <br /> Chwackw of so'to&depth of 3 'S*t-' Sand 0 Gravel C1 Sandy Loam 0 Clay Loam C3 Cla <br /> Y 0 <br /> Adobe 21-H <br /> ard n <br /> P"rAOUS APPk&hm Mad*; llf yes,clote.. ...... ......... ) No Z-��New Construction: Yes 0 No FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No wpfic tank or cesspool P&rwatsd if public sewer is available within 200 feet.) <br /> Septic T It Distanc-a from nearif <br /> A2P-,*�`Oistance from foundaflon..LSQ_...... <br /> No. of compartmet.. ...... ...........Size...................._­­Lquid d*F,.th..... ........ <br /> ,W <br /> 4 Capacity................. <br /> r=: Distance from nearestDistance from foundation,.��4 <br /> ' <br /> Distance to nearest lot line <br /> Number of 11"es-........�v.................Length of each line.._.... ......... <br /> --...........Width of-. anch-,_2 ------------ <br /> Am Type of filter matarW!!Z;F..9,....... , Depth of filter material.....if.' <br /> ...........Total Iongth...... .4 <br /> Seepe" Pit' Distance to nearest well ....... . ........Distance from foundation......._..... ....... <br /> Number of pit&................ -Lining rnaterial..... Distance to nearest lot jifle.......... ... <br /> S;ze. Diameter............. _......Depth.-._..... ..... <br /> ............ <br /> Cesspool: Distance from nearest well...............Distance from foundatior, Lining material <br /> S' : Diameter. .... ..... ............. <br /> ize ............ <br /> .. ..... ........ Depth........................... ... . .....Uquid Capacity. ............ <br /> ...........9& <br /> Privy: Distance from newest, well.. _. <br /> ..... I... ....... .... Distance iroTronanearest building-_. ............. <br /> C3 Distance to nearest lot line. .... .... .............. <br /> .................... .. ..... .......................................... .........."I........... ....... <br /> Remodeling and/or repairir. describe <br /> mAp........m.... ..........___ <br /> . ............................ <br /> ....... .............................................................. <br /> ........................................... <br /> ................................................ <br /> ................... ........ ........ ................................................................................... - ...... <br /> 1 ha"ObY COWIfY that I have Prepared this appfication and that the work win be done in accordance with San Joaquin Count <br /> ordinances, State laws. and rules and regulations Of the San Joaquin Local Health District. <br /> (Signed).. . . <br /> . ..... ...... ............................... .......... ... ................. -1.1.. ............................-40-mer and/or Contractc <br /> .................... ----------­...... <br /> ;+ p6 <br /> rpf -.4—' —C <br /> (Ph n, 09 4n of lot. llocafice of system in relation +*wel <br /> 6. bus etc, can be placed on reveres side� <br /> FOR DEPARTMEN SE ONLY <br /> APPLICATION ACC7!EPnTED -—"`" .................................... <br /> ............................. DATE.._;��9- <br /> REVIEWED BY..................... ... ............... ...... ...... <br /> ... . . .......... <br /> ................ .... . .... .... ........ DATE.................. <br /> BUILDING PERMIT . .. . .......... ....... .... ......................... <br /> ........................ <br /> Ahalrations and/or recafffirnandefiem:..... .................................... ........ ..... ......... DATE............... ........ . ......... ......... <br /> ............ ............... ................................................................ <br /> .......................------..... . ............... .......... ............................................. ......... <br /> ............................­­­ ...... ...... .... .. .. <br /> .......................... .... ... . ... ... .. ......... ------ . ...................... ... ...... ...... <br /> ... .. ...... <br /> FINAL INSPE-CTIOr <br /> Date <br /> AN J'OAQUIN LOCAL HEALTH DISTRICT <br /> HwuWaft"Avg. 300 woo o"%"*" 174 sycr­*S1,00f 205 W--"Wk Sore.* <br /> • r_Q <br />