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1 <br /> APPLICATION FOANITATION PERMIT Permit No. <br /> (C9 ptete in b Du licafe) `6� ) S <br /> �Ea� �11ikt f�r��` j, Date Issued -- -------------- <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Th�isa pplfcatj,pn s�ma�dC coryp�lian *i C�n�ty Ordir�,anTe l`lo. 549. f <br /> Th- <br /> '�� r ��*l1 ,1 fLn I hl +, �Gh it �c►�+ ` AlR ii�tJ �S ��l <br /> JOB ADDRESS AND LOCATI N. � _______: 1 - ____ t� ----- --- �� <br /> 'rr _�_ ..__e_ . .-- Lc-�- ---------------------------- <br /> Owner's - ----- ------- ---�' ---Uwl ------• ---------------------------------------------------- -- <br /> ­LcPhane_r± :. r 37y-- <br /> .►�.. t a R •-------------•------------------------..._.-----------------------------------••---•--------- <br /> Address_�P ,__....._ �J- ;x <br /> r <br /> 's Nam e Phone_ .__.5� fc------ <br /> Contractor <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1_--_ Number of bedrooms _'z__ Number of baths J---- Lot size __�_�_(}____! @ASF __________________ <br /> , <br /> Water Supply: Public system El Community system El Private �epth to Water Table ___.___r- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Rill," New Construction: Yes R No ❑ <br /> - 'TYPE"OF`INSTALLATION AND SPECIFICATIONS: ""— <br /> (No septic tank.or.cesspool permitted if publc.sewer�,is available within 200, 0 feet.) <br /> Septic Tank: Distance from nearest w�S�_______Distant from fo rndatfio__��.------------Materi __F___ ______ __ __ ______ '__!<__.____ <br /> -----Size-�. •- lA--- -Li uid depth--- --f------------ P y...._ <br /> No. of compartments____________________ C-- acit --�-- <br /> D-+sposa Field: Distance from nearest well-_- ------Distance from foundation___ .___._-----Distance to nearest lot lin <br /> e___.._. <br /> Number of lines---.__1---------------------------Length of each line----- Width of trench_.___ ----_---------------------- <br /> Type of filter material-___ --.....Depth of filter material-._.:_ ------- -_-Total length_______ ________________________ <br /> Seepage Pit: Distance to nearest well.....1.0-0--------Distance from foundation____._. Distance to nearest lot line — -A � <br /> 541, Number of its_''-- ---.-Linin material;-Sr�-!--------Size: Diameter----' --Q----- <br /> --.----Deptn-------------- <br /> Cesspool Distance from nearest well_________________Distance from foundation----------......... Lining material__________.___-__________________. <br /> ❑ Size: Diamefer.- Depth------------------------------------------- ------Liquid Capacity----------------------------gals. <br /> Privy:' Distance from nearest well ___________________--------------------------___Distance from nearest building-------------.--_________._______._____--- <br /> ❑ Distance to nearest lot line--------------------------------- ------------- --------------------------- ----------•------------------------------------------------------- <br /> Remodeling and/or repairing (describe):__ � -------------- <br /> s , <br /> ------------------ ---------------•-----------------------------------------------------------------------------------------------------------------------------------------------._._..---------------- <br /> I hereby certify that 1 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 Joaquin Local Health District. <br /> (Signe ----- -- . -------- .......................---• -=----------------------=-------------------------- ---(Ow and/or Con _ tor), 1 <br /> (Owner frac <br /> Tale <br /> tB • ---- ------------------------------------ - ---------- { • )(Plot=pn, showing size- f-lot;location-of•system-in-relation-to-weHs, buildings, etc., can�be-placed on reverse idi): <br /> F R l]EI?i� -T--M---EN U_SE ONLY 1 <br /> APPLICATION ACCEPTED BY________ __ _ ____t_ .,._ -�_.-_e� �-~�_-fr --- DATE-_ -- -------- - -------------_------- <br /> -J f------------ <br /> REVIEWED BY-- -------------------- -------:----- -----�- ----------------- --------------------- --•------------------------•-- DATE-------- ---------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> -------------------------- i <br /> Alterations and/or recommendations-----------------------= ------------- ------------------------------------------•------------•-----------------•-----•-- --------- <br /> ------------------------------------------ <br /> ------- <br /> -----------------------------------•------------------------------------------------------------------------------ <br /> -----•----L---------------------------------------------------••----------- -------•------------ ------ <br /> ------------- ------••-----•--------- <br /> ------- <br /> 7� <br /> FINAL INSPECTION 13Y:.-- Date_.._ _._. --------..............-------------- i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5�9 745446 ATWDCD <br />