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rUKUrHCE USE: <br /> ---------- <br /> ----------- ---------------- ------- ----------------- - APPLICATION FOI�,.�6N <br /> ,ITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> ------------------------------------- ----------- - - Tl,iki permit :iiijDires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Heal+.k District for a permit to construct and 'install the work herein described. <br /> This application-is.mad_ ein compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- ---J--g---0- j----k------ <br /> ION- - J- ------------j------------- <br /> --------- <br /> Owner's Name-------------;.--------- -------------------------------------------------------------------------------------- <br /> d 44/0 <br /> - - -------------------------- ----------------------- ---------------------------------------- Phonep <br /> Address 0-_ ? &� '7 Kroq_ <br /> Contractor's Name-------------%AAPtF -------pk_ft.a�s�------------------------------------- ----------------------------------------.-- Phone <br /> Installation will serve: Residence 0 Apartment House 'Commercial E] Trailer Court El Motel El Other D <br /> Number of living units: __Q___Number of bedrooms'____- Number of baths <br /> I _R__ Lot size ---14�q —---------------- <br /> Water Supply: Public system [9--Communitysystem [] Private 0 Depth to Water Table __.----- ft. <br /> Character of soil to a depth of 3 fe6'f: -Sand E] Gravel D Sandy Loam [] Clay Loam E] Clay El Adobe [Hardpan <br /> ❑ <br /> Previous Application Made: (If yes,dote____________________) 'No [ New Construction: Yes Ej- No 0 FHA/VA: Yes ❑ No E] <br /> I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank.or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Septic Tank: Distance from nearest well_N0w1-- Dist,nce from foundation_-le' <br /> ------- Material.__ 1UCrZKR_ <br /> No. of compartments----------1Z---------- j' -------- ----------------------------------- <br /> ------------.-Liquid depth--- <br /> JA-------------Ca pacify-_Y-01C) <br /> ------------ <br /> Disposal Field: Distance from nearest weli--------- 7 <br /> - _ Mtance from foundation---ZP--- <br /> --------Distance to nearest lot <br /> Number of lines_;---------�2---------------------Length of each line----------:50------------ Width of trench--------- <br /> Type of filter maferiaf---�i-PO­k---------Depth of filter mafer;aI_____A--------------Total length- Z <br /> I �So--------------- <br /> Seepage Pit: Distance to nearest well_4)6�1��--______Distance from founclation_/Pv_" 10.e <br /> --.--.--.Distance to nearest lot I I ne-_ <br /> Number of pits._ ----------Lining maferial----126�&------- Size: Diameter--- Depth_____________ -------- <br /> ------- ------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----_-_.__--- ----.Lining material__- _-__________-__--______ <br /> Size: Diameter-------- ------------- -------------- Depth-------------------------------------------- - Liquid Capacity----•-----------------------gals. <br /> Priv ' <br /> y: Distance from nearest well-------------------------------------------------Distance from nearest building-.----------- -------------------- ------ <br /> D Distance to nearest lot line-._______________________________-__-____ <br /> -------------------------------------------- <br /> Remodeling <br /> ine------- ------------------------------------Remode6g and/or repairing (describe):___ ......... <br /> -------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------- - -- ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------- ------­-------------- ---------------------------------------------:----------------------------------------- <br /> ----------------------------------------------- <br /> -----------------------------I------------- ------------------A--------------------------------------------------------------- <br /> -- ------ - - - ----- -- - ------ <br /> I hereby certify that I have prepared this application and that the work will--6-e--done- <br /> in-'accordance--with--San-,Joaquin---County <br /> ordinances, State laws, and rules andf gulafions of the San Joaquin Local Health District. <br /> (Signed)�__I----- _-, } <br /> - <br /> ---------- ------------ ----------------------------------------------------------------------(Owner and/or Contractor) <br /> BY:--------------------------------------------- ITitle <br /> i <br /> -- ---------- -----------------------------------------( )--------------------- ---------- -------- - --(Plot ------- <br /> 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 /> APPLICATION ACCEPTED B J ----------- - --------------------- ------------------------------------------- DATE__-_... <br /> W Y <br /> ---------------------------------------------------- - <br /> REVIEWED BY <br /> DATE------------ ....... <br /> BUILDINGPERMIT ISSUED -------------------------_ ------------------------------------------------------------ <br /> ------------ ---------------- DATE <br /> Alterations and/or recommendations:.__ -(�,G � .2 -7-3;-------------- <br /> --------- --------------------Y��-- ---- ---------------------------------------------------------------I-------------,------ <br /> ----------------------------------------------------------- ---------------------------- ------------- -------------------------------- -------------- ------------------------------------ --------------------------- <br /> ------------------------------------------ ------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------_.- <br /> ............I----------------------- - . ......... --------------- ------------- ---------------------------- ------------------------------------- -------- ----------------------------------------- ---------------------- <br /> ------------ ------------------- ------------------------------ ----------------- --------------------------------------------- ------------- --------------- ------- ------ ------------------------------- <br /> FINAL INSPECTIOI`+ <br /> - ---- --- Date. <br /> S -------- <br /> ---------------------- <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naze, an Ave. 300 West Oak Street 124 Sycamore street , <br /> 205 West 9th Street <br /> Stockton,California Lodi,California <br /> Manteca,California Tracy,California <br /> F.P.C ci. <br />