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FOR OFFICE US <br /> Per <br /> _�3_ ---� <br /> fi� -mit Nb. ­/. .-----.._.K <br /> 11TATION PERMIT <br /> APPLICATI' OR SAK <br /> 4 7 (Complete in Duplicate) <br /> �J7 <br />------- ---------------:---------!---------------------- Date Issued <br /> --------_'l----------------_--.---, -I This Permit Expires I 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 compliance with County Ordinance No. 549. <br /> 4W317 4j 419 1,,_ge — z, V <br /> ....... ... .... .. .... <br /> ... ..... ....... <br /> JOB ADDRESS AND LOCATION--------------1------- AA <br /> Phone.......----------------------------- <br /> Owner's ------- - ----------------- <br /> _._4--- ---- - -­­ ------------------------------•--------------.....----. ----------------­------­----------- -------------------- <br /> Address--------------- ----- rn <br /> Phone-------------------------- <br /> Contractor's Name------- ................. ------------------I------------------ --------------------­----- <br /> Installation will serve: Residence 0Apartment House El Commercial [] Trailer Court [I Motel [] Other 11\ <br /> Number:of living units: _--2... Number of bedrooms --- Number of baths .-;L- Lot size Cl ... ---------------- <br /> i, W <br /> Water Supply:: Public systemuOmmunity system El, Private V( Depth TO ator Table aWft. <br /> I [] Adobe[] Hairdpn FCharacter of soil to a depth of 3 feet: tSandGravelW,[j Sandy Loam Ej ay Loam E] Clay <br /> -------------------- o ❑EK-New •Constructid. Yes 2r-'No FH-A/VA.. Yes E] No <br /> Previous Application Made: (if yes,date <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Let.) <br /> P'l 'thin 200 <br /> (No se fie tank or cesspool permitted if public sewer is available within <br /> ell__47A_"�_��Distance from foun`d6tion.11A.............Material..., — <br /> (�P,4ic Tank- Distance from nearest w jP------------------------------------------ <br /> No. of compartments..__-__ Z-------------- ------ ---Liquid Cape <br /> to nearest lot line_.CtS ...... <br /> Disposal Field, Distance from net11 Distance from foundafion_!!.'q..............Distance xwe ...... .... I <br /> - _K rve------ ------J-A <br /> Number of lines,�W-_ --4 -----Length of each lin"j— idth of trench-------4$_-'f------------------ <br /> &4, <br /> :.__-.._-Depth of filter teriml.1k.-A------------Total _Ap -----...... <br /> Type of filter material--------0 CA ma ,length__ ----------------- % <br /> L.----- Dista nice to nearest lot line................. <br /> Seepage Pit: Distance to nearest well'-—----------------Distance from foundation_ i <br /> -------------------- <br /> Number of pits------------------ Linin material----__.\-------�_,Size: Diameter--------------------_Depth------ <br /> 11 i **F�' & N N 1* <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------1070.70_0*.Lining material------------------------------------- <br /> Size: Diameter--------------------------------`Depfh----------------------------------------------------Liquid Capacity----------------------------gals. <br /> r_1 M W <br /> Privy: Distance from nearest.well------------------ ---------------*------Distance from nearest building------------------------------------------ <br /> Distance to nearest lot line---------------------------------------------- -------------------------------------------------.1.1---------------------------------- <br /> ❑ <br /> Remodeling a"nd/or repairing (describe):--------- ------- <br /> -- ---------- ..... ........... <br /> ------------------------------------------------ _ <br /> ---------- <br /> ------------------_--------- -------------------------------------------------------- <br /> 0 ------------_-------------------- --------------------- <br /> ---------------------------------------------------------------------------__------------------------------------------------------------------------_------------- <br /> 1� .................................... <br /> ----------------------- -----­---------------------------------------------------------------------------------------- ------------------------------------------------------------- <br /> I hereby certify that I have prepared this applic ion an joala, ll�e work will be done in accordance with San Joaquin County <br /> Ic <br /> q'i <br /> 10 a J, c <br /> State laws, and rules and regulations aofe Sal al Health District. <br /> ordinances, , <br /> -------------------------------------------------------------(Owner and/or Contractor) <br /> -----------I---------- --------- -- ----- - -- ----- <br /> (Signed)---- ----------------------- <br /> By: --------------------------------------- ----------------------------------- ----- ---------.... (Title]----------------------------------------------------------- -------------------- <br /> ....... ----------- <br /> .(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FO ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- ------ ----- --,e--------------- -------------- ---------------- DATE--------�1142le-1--3------------------ <br /> REVIEWEDBY----------------------- -------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED...............-----------------------------------------------------------_--------------------_-- DATE------------------------------------------------------------- <br /> 1� <br /> Alterationsand/or recommendations:---------- -------------------------- ------------------------------------------------------- -------------------------------------------------------------- <br /> ----------- -----------------------------------------------------------------------------------------------*----------------- -------------------I--------------------1-1-------------------------­.......... <br /> 4--------------------- --------------------------------------------------------- ---------------------------------------------------------I------------------------ ------------- ------------ •--------------- <br /> .............................................. <br /> -------------- ............I­--------------------------- ------------------------------------------------------------- ­------------------- <br /> ------------ -------------------- ----------------------------- - --------------------------------- -------I-------------------------------------------------------------- ----------------------------------------- <br /> FINAL INSPECTION BY:-. Date-----77 �------------ ------------------------ --- <br /> ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 306 West Oak Street 124 Sycamore Street 205 West 9th Start <br /> Stockton,California Lodi,California A. Manteca,California Tracy,California <br /> es 9 REVISED 8-59 2M 5-62 ATLAS <br />