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-� <br /> ---- <br /> ------------------- <br /> - ------------------------------------------------ <br /> - <br /> __-. -- --- APPLICATIONh FOR"ANITATlO - <br /> N PERMIT <br /> ------- Permit No. .... <br /> - _ . (complete in Duplicate) <br /> This Permit ex ires 1 Year From Date Issued <br /> /application is hereby made to the San Joaquin Local Health District Date Issued <br /> This application is made in compliance Joaqu n Lo,fy Ordinance No. t fo <br /> rct fora permit to construct and install the work herein described, <br /> JOB ADDRESS AND LOCgTION_:___ � � <br /> ,,,, <br /> Owner's•Name_=--vi 1 1E <br /> l_ <br /> Address._. ilk%�i= _._ = __.- - <br /> ' ------------------------------- <br /> Contractor's Name___, A on ---.- <br /> fir_ h <br /> ---- -----.- ----' Phone <br /> Installation will serve Residence ( � <br /> 1_ _�= i <br /> (�. Apartment House Phone.___- <br /> 'Number of living units: -j---- Number of bedrooms Commercial <br /> Trailer Court ❑ Motel <br /> Water Supply: Public system # --- Number of baths _-__. -1 ❑ Other ❑ <br /> COmmLfnit _ Lot size --- - <br /> Character of soil to a de th of 3 feet: Sandy system . * ] 9- ----._ _ t <br /> ❑> Ixrivate ❑ Dspfh to Water Table <br /> p Gravel <br /> Previous Application Made. � ❑ Sandy Loam <br /> (If yes date.__ " ❑ Clay Loam [] Clay Adobe <br /> TYPE OF INSTALLAr1ON AND SRECIFICgrrONS ,, New Construction:`Yes o '� Hardpan [] <br /> Z. <br /> (No septic tank or cesspool'permitted if public sewer is available wi ❑ FHA/VA. Yes ❑ No <br /> Septic Tank: <br /> Distance from neares# well-] thtn 20� feet,) l ] <br /> IN No. Of'compartments, i__- ���� Distance from foundation__-- <br /> ` et e -- ---_-_Material <br /> Disposal Field: �" Size-411t� C`_ - _( '- <br /> Distance from nearest wail. 1p Kms- ,pistanc from foundation.Liquid depth_~-- / <br /> ' .--- -- Capacity---) <br /> ® Number of fines------I-_ l_L�__.-_...-Distance' <br /> ......................Length of each line------on- to nearest lot line-_---- <br /> * Type o{ filter material- - i �_f.-`- - <br /> ------------- Width of french---' -4_i i _ -­V'04, o{ filter material__----i_, <br /> Seepage Pit: I , <br /> pits well- y1�17 --Distance from foundation Total length_---_---- - —�7 <br /> Number of i p i��--•�-) <br /> Distance to nearest <br /> - --------Lining material_ 10 -•-•---- Distance�to nearest lot line_---$ r <br /> Cesspool: r -SIC-_Size: Diameter._. _; <br /> Distance from near Size:well-----------------Distance from foundation--_--_-_-_ <br /> ❑ `�' -�._ _.Depth_ 10 <br /> Size: Diameter----- --- --------- ------ <br /> - Depth- Lining maferial_._.._. <br /> Privy., Distance from nearest well._--__- <br /> . Liquid Capacity----------- LA <br /> Distance to nearest lot lire___-_-_--_ ----------Distance from nearest building_-_.__- gals <br /> f ____ ______________ ............. <br /> -_---____-_____-.-______f- <br /> Remodeling and/or repairing I'descr;be}:_--_-_-_ -------------•----------- <br /> C <br /> - -------- <br /> --------------------------------- a ------------------------------------ ------------------------------ <br /> -------------•--------------•------•-•-------- r----------------- <br /> --------------------------- <br /> ---- --- <br /> ----------------------------- ---------------- -------------- - - <br /> b i ----- <br /> I:hereby certify that l have prepared this application and that the work will be done in acc <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> '"`'"` " >i'" � ordance with San Joaquin County <br /> (Signed)__ <br /> ------- <br /> ---------- <br /> r - --------- --- <br /> ----- <br /> (Plot plan, sh wing size of lot, locafion of sstem in relation to wells, buildings, a+--- can be la wrier and/or Contractor) <br /> or] <br /> -- --------- ---------- --(Title}---------- <br /> y' p cad on reverse side). <br /> t <br /> I FOR DEPART;IvIENT IJSE ONLY <br /> APPLICATION ACCEPTED BY_- ' ' <br /> REVIEWED BY---- ----- --- f----` ---------------------------- <br /> `---I �R` ` `''----------- <br /> � --- --------- ------ ---- - DATE <br /> -------- -------�-------------- --- - ----- - <br /> BUILDING PERMIT ISSUED--------------- <br /> ATE <br /> ------- --------- --------- <br /> A terafion an / rec mmendaticnts:-_---__-_/ _ I <br /> f DATE --------- ------------- <br /> s:. ------- <br /> `� <br /> p `�- -------- <br /> ________________________________________________________�._-._._-__-.._._ 4�4 -- <br /> e <br /> - ----------- - <br /> LC <br /> --------- - --------------- ---------- --- <br /> ----- -------------------- -- <br /> FINAL INSPECTIOf�-BY:----------- ;--------- <br /> ..�. .�..---.---�. <br /> r <br /> -- .,.. <br /> --- ----- - Date � ...� <br /> `t <br /> OAQUIN LOCAL HEALTH DISTRICT`it, ak StreetR 124 Sycamore Street_ 205 West 9rh Street <br /> ��'�0��1 � KlGnteca,GatiEvtnia l�hiCY�CQI\EO�RIQ <br />