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APPLICATION FOR NITATION PERMIT Permit No:r_...... 3o J <br /> ` . (Complete in Duplicate) <br /> Date Issued -----!1_34a <br /> Application is hereby made to the San'Joaquin Local Health District for a permit f8 construct and install the work herein described. <br /> This application is made in corn piia ,with County Ordinance No. 549. . <br /> JOB ADDRESS'.AND CATION_----------- ----.2--- I <br /> - <br /> - P ✓ ---- - ---- <br /> Owner's Name----- <br /> ` I - <br /> - -------. . Phone.— <br /> Address... <br /> 2 _ ; --• - - ------- -- <br /> Contractor's Name____: Ph <br /> -------- ------- ------- one_ <br /> Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Motel <br /> I r ❑. Other ❑ <br /> Number of living units:,. ___,Number,of,bedroom$ _-�.�____-N.umber of.baths _ _ Lot size _ _ <br /> Water Supply: Public system Communitysystem I <br /> y ❑ Private ❑ Depth to Water.Table e, ff. <br /> Character of soil to a depth of 3 feet:' Sand F] Gravel E] Sandy Loam Ej Clay Loam <br /> 3 <br /> El Clay El Adobe Hardpan E]' Previous Application E]Made: Yes No New Construction: Yes No ❑ „FHA/VA: Yes No,� <br /> 74 � r ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: " <br /> (No septic tank"or'cesspool permitted if public sewer is available within 200 feet.) }.., <br /> p from foundation---4------ Material <br /> No. of compartments Size---- --- ------Liquid depth------------- Capacity. <br /> eptic an Distance from nearest wel!____-_.______..-Distance <br /> pY---------------------- <br /> Disp s Field: Distanc� from nearest well__ ____________'Distance from foundation______�"_. _=__..Distance to nearest lot line___._______-____. <br /> t <br /> Number of lines__- Length of each line____________ ___ I,! Width of trench----------------------------------- <br /> 7 <br /> -____ _-__ """_-""""---"-" . <br /> Type of filter material" ---------------Depth of filter ma rral----------- <br /> • ., Total length ----------•----.. <br /> h W <br /> Seep ge Pit: Distance to nearest well: _"___Di an e frame �n ation_._____ <br />• ------.Distance to nearest lot line_--_ <br /> Number of pits____ ___- :Lining me> �a <br /> i'Size: Diameter_----_eel <br /> Depth---------:0 <br /> 4 Cesspool: Disfance'frbm'nearesf well_ "' �~pi <br /> �: _.from foundstion----------�------.Linin material---------------------------- <br /> Size: Diameter---------------------------= De th ------=--------- I------Liquid Capacity----•-------- gals. <br /> Privy:.;'_ Distance from nearest well.___-__- t <br /> ___.______.____-Distance from) nearest,build'rn <br /> ❑ Distance to nearest•lot-iine---" t m ' _ *' •. <br /> y -- - ----------------- ----- ---------------------------- <br /> Remodeling lancl/or <br /> ---- --------------Remodelingland/or repairing.(describe):___- " <br /> --- <br /> ti , ------- <br /> ------------------------------- <br /> - <br /> .: ---------------•-'`--------- ----------- <br /> - <br /> I a <br /> r � 1 y – tR �n _- ----- ------•---- --------------,T ---------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------- <br /> 1 <br /> herby=cerfify thaf'I have prepared this:eppli tion and that the work will be done in accordance-wi+h San Joaquin County <br /> ordinances, Stafe i ws, .and r les nd regul -ions o fhe n Joaquin Local Health District. 1 <br /> {Signed)_ } = <br /> '-----.------------------•- (Owner d/or Contractor) <br /> By:----------- --:. - - ' <br /> --------------{Title_- s 3 ___ <br />/Pl�l plan, showing size`of lot, location'of system in relation to•:wells, buildings, a+c., can be pl cad on ever side. <br /> ` �. r ) <br /> FOR DEPARTMEN'T,USE ONLY [ ^•1 <br /> APPLICATION ACCEPTED BY_____________ <br /> 4 --- -------------------------------------- --------=----- DATE F <br /> REVIEWED BY------------�--'-:--: �_ _ � "�' � � 1� - --------------•------ �---- <br /> BUILDING PERMIT ISSUED---'---- - = - 1 ----- DATE------ -------- ----------- <br /> - ------------------- <br /> and/or recommendations: - DAT - <br /> E - -- <br /> -------------------------------- <br /> ------- <br /> ------------- '_9-s -- --- -PTfa � } $` ?��rF`= <br /> ---------------- ---- ------ '�. Gc---- ----1�,_{ - - --•-----•---- <br /> � i/%�1 ' r ----------•- <br /> - -•----- <br /> " �!` �r <br /> -�-- = - <br /> sfi �a��- --/-- ---- <br /> ':_._- ��>��c_ -_ _..- J,� ' =----- --- <br /> ------- <br /> FINAL INSPECTION BY:. = ----------- <br /> ,C7k 'C1 --- ---= Date = - . <br /> 5 g <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes{ Oak Sfrae{ 132 Sycamore Street <br /> 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> Tracy, California <br /> ES--9-2M : Revised 1.57 F.P,CO. <br />