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�- -" FOR OFFICE`USE: �< <br /> : ... ".. ...."-- - .--..""-.--"--."-"-. APPLICATION FOR ANITATION PERMIT Permit No. ...... ...� �± <br /> ----------- --- -- -------------------- (Complete In Duplicate) SC NNEQ 7/ <br /> ......---." ..------- This Permit Ex ires 1 Year From Date Issued ate Issued ..._...�-. •. .� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wort: herein d1med. <br /> This application is made in compliance with County Ordinance No. $44. <br /> JOB ADDRESS AND LOCATION- .. *..... <br /> Owner's Name.................l ..j..---••-..... /k•' <br /> Address ..il_.......- -•........................................................••--•-•-------••-••--•------.....-•---- <br /> Contractor's Name.-.--.- syr--------------•---••-------••--••-----•--.... ................ ........................................... Phone.................................. <br /> Installation will serve. Residence JX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -.f..... Number of bedrooms _.k _. Number of baths Lot sizeX7.4.".2.-1.X........................... <br /> Wrter Supply: Public system ❑ Community system ❑ Private 10 Depth to Water Table 4a ft. <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 10 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> t Previous Appiic:etion Made: (If yes,date...... ------..) No ® New Construction: Yes JP No ❑ FHA/VA: Yes ❑ No❑ <br /> y TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if puble aewor is oval"etriilhit Opp faeta <br /> Septic Tank: Distance from nearest well_ b.._.Dista fro fou dation.__.�.f2........Material______ <br /> No. of compartments------I...••-•-•-•-•..Size-- -- ----- -------I 'Liquid depth_.,T-----------------Capacity..���.Q....... <br /> .Disposal,Field: Distance from nearest well_..-'.4_......Distance from foundation.__i-v........Distance to nearest lot line.---_-.... <br /> Number of lines...... ... Length of each line.�_.'�_f,�.................Width of trench... !l�.��........ <br /> ............ <br /> Type of filter materia '.. )7�Dep•ttl of filter material---4?'_..........Total length.-_Al..o..?....................... <br /> Seepage Pit: Distance to nearest we ......................Distance from foundatiorL...................Distance to nearest lot line................. <br /> ❑ Number of pits.--•---•---•----------Lining matetial.......................Simi Diameter........--------------Depth................... <br /> Cesspool: Distance from nearest well.................Disiance from foundation....................Lining material....................... <br /> �. ❑ Size: Diameter Depth Liquid Capacity gab. <br /> Privy: Distance from nearest well----------------------_ __•-._:._:__._�....__Distence from nearest building---------------------- <br /> ❑ Distance to nearest lot line..................... ............---.•,-" .-•. <br /> Remodeling and/or d repairing describe - . <br /> Pag <br /> .• _....._...............--................-........................................... <br /> ._..... <br /> _............................................ .._ _..... ----•----••-----•--•---------•---•--------------- <br /> ------"......--•-------•-••--------"•---•---•---••-•.....................-...............................,�.,;r �,- . ....t....................---- ---- . <br /> ._..... •-- - <br /> I hw*bY certify that I have prlpared this application and ties!#6 aril trip be d0ne in accordance with San Joaquin ty <br /> ordinances. State laws, and rides and regulations of #6 San Joaquin Local Health District. <br /> (Signed ---- <br /> •' .__...-._(Owner and/or Contractor) <br /> By-....................................................................................................-•--- (TItIe1 <br /> (low plan. showing 66 of 66. lecafto OF opoern in raim*=to Wok bWWh 9% eta.. can be placed on reverse side. \ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -----------•-•-••-•-----•------------•---------••---- DATE... A-4l I........_•--�.........• <br /> REVIEWED BY.... _.. .....__.. ........ .... ...••------...........:.._......--•.....---•--.I...... DATE.. •._..., <br /> BALDING PERMIT ISSUED..---w ­.._............�._�.........�._............. •- DhTE. --..... <br /> ........ <br /> Ahwatrera Ind/or �r i....M.....--- .......................... «... .............. <br /> • f .............................................................................................. <br /> ............................................................................. ........................................................... <br /> FINAL INSPECTION BY:.... l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Louth American street 300 Warr Oak smw 124 Sycamore Street 205 West 9th sheet <br /> Stockton,California Lodi,Callfernia meahma,Califernla <br /> Tracy,Callfarnla <br /> -" [� 9 k[VI![e 5•89 •M a-AT ATLAa <br />