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FOR OFFICE USE: <br /> q o 00 <br /> Appbi:�TrION FO"l NITATION PERMIT Permit No. <br /> --------------------------------------------------------- <br /> -------------------------------------------------------- (Complete in Duplicate) Date Issued <br /> --------------------- -------------------I-------- This Permit Expires I 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 compliance with County Ordinance No. 549. <br /> J ----------------------------------------------------------------------- ......... <br /> JOB ADDRESS A7 Lq.!.��ATI 0 IN......... --- r;r ( <br /> ------------ ------ ------ <br /> .................................... Phone-------------- .............. <br /> Owner'! .. ................. j� --------------------------------------------------------------------- <br /> - I -r----------- <br /> Address------/C­__.,."JhL Y�---o�-A-.;2--r.................. ................................................................................................. <br /> ...................... <br /> . ............................................... <br /> Contractor's Name.----------------------- ..... ---- ----------------------------------------------------- Phone............. <br /> Installation will serve: Residence Apartment House E] Commercial 0 Trailer Court E] Motel 0 Other El <br /> Number of living units: -_--L Number of bedrooms ...../-. Number of baths ____--r Lot size ------ ........................... <br /> Water Supply: Public system E] Community system Private E] Depth to Water Table ."----- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam K Clay Loam E] Clay 0 Adobe[] Hardpan C3 <br /> Previous Application Made: (If yes,date____________________) No � New Construction: Yes � No El FHA/VA: Yes El Nolt, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public serer is available within 200 feet.) <br /> Septic,Tank: Distance from nearest wellL:.�'.d.P ,t) (/ - - ............ <br /> -------Distanr,,e from foundation------/_(?......M/aejai--- h <br /> No. of compartments_____2--------------- -----Size--- ...Liquid depth__-------------%-----------Capacity...�Is----------- <br /> Disposal Field: Distance from nearest II_----_> ---Distance from founclaf- n- <br /> .7 y <br /> r w 1 ----.,.Pistance to nearest lot life ........... U <br /> 4 <br /> Number of lines........... ---------------Length of each line.-.____.___--_-------- ------ ------7Width of trench------- _----------------- <br /> Type of filter material.' Depth of filter material----IQ--------------Total length--___.___-[_5 ......................... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation...................Distance to nearest lot line..__............. <br /> VVV <br /> 171 Number of pits---------------_-.-__Lining material-----------------------Size: Diameter-_.----__---.-.._._-___Depth_.-.--.__.-_.__-_.___-__-..___--- ..�• <br /> Cesspool: <br /> epth----------------_-------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._----------------Lining material-______-_-___-_ ---_------ j)l <br /> 0 Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------•-gals. V0 <br /> Privy: Distance from nearest well--------------------------------- ------------Distance from nearest building--___-_ -_-_.-. _--_---. ------ <br /> 1-1 Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------------------------------------------------.................................................................................................. <br /> ............I------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------......... <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfafejaws, and rules and r e ulations of the San Joaquin Local Health District. <br /> veli C V� <br /> (Signed)---- -------_--------------------------------------------------------------------------------—----------- ---------------------------------------------(Owner and/or Contractor) <br /> By:................................................................. ------- ---------------------------------------------------------(rifle)---------------------- ------------------ --- ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------------- -------------------- --------------------- --------- ------ DATE--------------------------------------------------------- <br /> REVIEWED BY------------------------------------------------------------------- ----------------------- l - - DATE......-..- <br /> — c --------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------- / ------------------- DATE------------------------------------- ------------_---------- <br /> Alterationsand/or recommendations-------------------------------------- ------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------­­-----------------------............................................................................................... <br /> ------------------------------------------------------­- ------------- ---------------------------------------------------------------------------------------------------------------------------........................ <br /> ---------------------------------------------------------------- ------------------------I--------------------------­----------­-------------------------------------------------I-----------------------------­----- <br /> ------------------------------------ ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION -------------- 2� ---------------- <br /> BY:------- Date-------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 96 9 REVISED 8-59 3M 3`63 F.P.120. <br />