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FOR OFFICE USE! <br /> ----------------------------------------- Permit No. . <br /> - APPLICATION "�OR'�ANI1r:ATlON PERMIT � -• �-f ' <br /> ----------------- --- ------ ------------- ------ ---- <br /> ---------- -------------_--...__------ (Complete in Duplicate) Date Issued _" 4��6 <br /> ------------ <br /> _..-___--.___--__--__- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in complia ce with County Ordinance No. 549. Z-6 —��_0 MTc a <br /> � <br /> p�- ���� ---0 ------ <br /> JOB ADDRESS AND LOCATI ____1-= E_ H..._ A _�___-- - - - <br /> j� ` Phone------------------------------------ <br /> _IF <br /> Name-----------{��-�.��L------•--�-�-----�,�,✓_��---------- ---------------------------------------------- <br /> Address - <br /> 1�_I �...1 n R`S �-A-NTES- -- ..------- <br /> * � Phone------------ --------•------------ <br /> Contractors Name----------------------------------------L- ---•--• --------.=----•------_------------------------- ------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court Motel ❑ Othe gESrR�N?r <br /> _ ----------------------- <br /> Number of living units: -_-__._ Number of bedrooms _-...._- Number of baths -------- Lot size`.--- -�� _ <br /> I . w ft. <br /> Water Supply: Public system ❑ Community system ❑T Private �Depth to Water Table r' <br /> Character of soil to a depth of 3 feet: Sand 'Zr Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0,.Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------_.---I No 21� New Construction: Yes [9�'-No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ,. <br /> (No septic tank or cesspool permitted if public sewer is available within'204 feet.) <br /> I <br /> Septic Tank: Distance from nearest well-----50.._Distance from foundation ------------------M serial-__ � C-r- -bT�---------- <br /> No. of compartments__,__ 1 -...._.__.Size._.. ?r.._.- .. Ca acit O__..�------ <br /> ..X_9.,! =S__.Liqu id depth_-.--- _ - P ,y----- <br /> Disposal Field: Distance from nearest well...._50---.Distance from foundation--;:�I - ."Distance to nearest lot line�-_��____ � <br /> Number of lines-----------:/-------------------Length of each line_!--_Er" p-`- -f---.,.Width of trench-------xr1- -------------------- <br /> Type of fitter material..-.f C)t.__Depth of filter material-_-----IT-P-----_Notal length-_-----��__�-------------------- a . <br /> Seepage Pit: Distance to nearest well-----.--_-----------Distance from foundation---------------._.Distance to nearest lot line--------- <br /> ❑ Number of pits ----------'---------Lining material------------- Size: Diameter - Depth <br /> Cesspool: D'staraco from nearest well-----------------Distance from foundation---.---------_-_.Lining material--.---------------------------------- <br /> Size: Diameter----------- ------ ---------------Dept h_---------- --------------- •---------- --Liquid Capacity------------------------ gals. <br /> ❑ x <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building.--------------------------------- <br /> ❑ o --- - --•- -------- --------------------------- --------'---------- ---------------- <br /> Distance to nearest lot line...------------------------ --- �----- - --r--- ------- <br /> Remodeling and/or repairing (describe):-------------------- ------------------------------------------------------ <br /> t 1 �- ------------------------------------ <br /> ------------------------------------------------------ il ----------------------------------- <br /> ------------- ---------- ------.----- .... == ----------- -----•------- --------•-----------= -----•------------------------------.--------. -------------- <br /> y� <br /> .., .. <br /> Ihereby cc NY that I have prepared this application and that the work will be done in accordance with San-Joaquin County <br /> ordinances, 'tate ws, and rules a regul ons of the San Joaquin?Local Heilth District. <br /> ._---.._____....._I------------------(Owner and/or Contractor) <br /> (Signe )----- - - <br /> $Y= — ------ --------------------------------------------------(Tif le)------------­-------------- ........... - <br /> (Plot 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 BY------- --- -----------------------------------------------0--------------- DATE------- ;-57 -7--46---------------- <br /> REVIEWEDBY------------------------------------------------------------------------------- ---------- DATE--------- ----------------------------------------•------- <br /> BUILDINGPERMIT ISSUED-------------------� ----------- ---- - ------. DATE------------------------------------------------------------- <br /> S.and/or recommendati ns: --------------------------- � <br /> � _..M <br /> --------------------------- -- - <br /> ---- ------------ <br /> ----- ----------------------------- <br /> - H��� <br /> FINAL INSPECTION ---- :. sYNJ <br /> -- Date <br /> QUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Havellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California .- Manteca,California Tracy,Caiifornia <br />