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' FOR OFFICE USE: <br /> -------------- <br /> -` <br /> ��� � <br /> _____________________ APPLICATION 1=0R 5ANITATIUi4 PERMIT Permit No. __._..:.____'.__..____. <br /> --------------------------------------------------------- {Complete in Duplicate) I / <br /> --.----.---. This Permit Ex ices 1 Year Fram,Date Issued Date Issued ___.__..>Aj <br /> Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIO "-. I_- ---- ._ � <br /> Owner's Name Y ----------------------------------- -•------------------------------ Phone..._----•--•------------------- <br /> Address7 R •----•-------------------------•--•----------•--.......--------------------- <br /> 1 <br /> Contractor's Name...... ------ ------------- ------------------------------------------- Phone....---- ---------------•---------- <br /> � r <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court �otel ❑ Other ❑ <br /> Number of living units: T_ Number of bedrooms S__ Number of baths _-ft_--- Lot size . � __-_ 1ZC-- ----------------------- <br /> Water Supply: Public system Community system E] Private [3Depth to Water Table �f_ ft. <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ja Hardpan ❑ <br /> Previous Application Made: [If yes,date--------------------I No ,New Construction: Yes ❑ No gR'-"FHA/VA: Yes ❑ No Z-� -- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: } <br /> (No septic tank or cesspool permitted if public sewer is available within"200 feet.) <br /> Septic Tank: Distance from nearest well------ <br /> -----_Distanc_e from foundation_..-.14!_____...Material---.6-45 �.'___ <br /> 49/� <br /> I!d No. of compartments---- ----------------Size4_!WJr',641t4Liquid depth----- _`_'_----------Capacity_ZZQ-0------ <br /> Disposal Field: Distance from nearest wel- <br /> l ---:' -------'.Distance from foundation-_--- -"__--_Distance to nearest lot line--- <br /> Number of lines---.. -_---�---____-_-__-Length of each line_- � .�____�.-_--.Width of trench-_-���'--- -------------- ''••33 <br /> Type of filter material �_ e Depth of filter material._---IZ_-_----_.-Total length------/R� __�------------------- W <br /> v - ,' _D <br /> Seepage Pit: Distance to nearest well '______._Distance fr m foun ation___" '---------Distance to nearest lot line...f __�..- d <br /> Number of pits------ ----------Lining' material-- __.__4k�...Size:. Diameter-----'E Depth--- --'--------------- -_,•J <br /> Cesspool: D;stance from nearest-well-----------------Distance from foundation--------------------Lining material------------------------ <br /> ____-. _ <br /> - --- <br /> ❑ Size: Diameter------------------------------------- Depth -----•-----------•-•------------='le77------- -Liquid Capacity----•--•-_---------------..gals. <br /> Privy: Distance from nearest well-------------------------i..___. :-. <br /> --------.-Distance fr'om.rnearest building--------.--_----_---_-_--.•_--_-----.----- <br /> ❑ Distance to nearest-lot line------_-___-_ .- _---- <br /> ------------------------------------------------ <br /> Remodeling and/or repairing {describer , ; f! r -... --------------------------------------- <br /> --------- <br /> - -.--•- <br /> } <br /> K. , <br /> I hereby certify that l 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. r <br /> (Signed)----------- ------ ----- Contract ) <br /> /1 <br /> .-..- -_ __..- `.. J <br /> - r or <br /> (Plat plan, showing size of lot, location of s in relation to wells, buildings, etc., can be placed on reverse side).. , <br /> FOR DEPARTMENT USE ONLY h'a <br /> f <br /> APPLICATION ACCEPTED BY-------- yrs,Q�. ----------------- --------------------------------------------- DATE--------!•4- `��' <br /> REVIEWEDBY------------------------------------------------------------------------------------------------=-------------------•------- DATE------ <br /> ----•-------------------•------------------- <br /> BUILDING PERMIT ISSUED ------------------------•----- --------------- DATE = <br /> Alferations and/or recommendations:_-.---------------------------------------------------------- <br /> ----------------­------------------+-----------------•------------------ --- <br /> --------------- <br /> --------------•------ '• -------------•----=--------- -----•--••------------------------------------------- <br /> eel ^ k <br /> Jf` �'----- - -----------r ----- <br /> ------------------------------------------- - <br /> �� <br /> FINAL INSRECTION� . ./--2-- - -----`-- -- -- -- Date.----.--- _..._!- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 1 124 Sycamore <br /> �treet 205 West 9th Street <br /> Stockton,California a , Ocil,California, , ` <br /> Manteca,Callfornia — Tracy,California <br /> E8-9 REVIBE9 a-59 F.P.00.2M 6.60 <br />