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j FOR OFFICE USE:, - <br /> .ri <br /> ------- ----- -------------- - ----------- <br /> N N5 t7XNITATION PERIulIT Permit No. .../..11 <br /> ------ <br /> �.. <br /> 'V i. <br />--------------------- a: -'-•--- M.. {Complete in Duplicate) <br /> 4 ' � i Date Issued ----���7 -Y <br /> _ This Permit Expires 1 Year From Date Issued <br /> ------- {��` <br /> Application is hereby made to the San Joaquin Local Healfh.District for a permit to construct and install-44 wok herein described. <br /> This application is made in com liancc�e with County Ordinance No. S49. 25'7- 170-0-3 a�h� <br /> �� t tom..._-. �,,� .✓ _ <br /> JOB ADDRESS AND LOCATION_ <br /> Owner's Name....-----i -•-•--- -T--0 -----•------------------------ ----------------- ................ Phone.........................---------• I <br /> -------- <br /> Address.........-------- .- ::_._. _ -3-__.-�--..-_---•-- 1- <br /> Contractor's Name------ ----------------------------------•----•--•-----------------------•-•----._.... Phone................................... <br /> Installation will serve: `Residence E!r' Apa)rtmenf­Nouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _L_ Number of bedrooms -7 Number of-zbaths -------- Lot size ._��Q_i��.��f................... <br /> Water Supply: Public).system [3 Community system El Private E/Depth To Water Table --------- <br /> Character of soil to a depth of 3 feet: Sand ❑I Gravel ❑ S ndy Loam lay Loam ❑ .Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made., (If yes,date,__.___ ____--.__.) No New Construction:-Yes No _ FHA/VA. Yes ❑ No <br /> _ __ _ . -� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-g rte. <br /> ..r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic nk: Distance from nearest well5 --'--Distance from foundation._._1�______--Moe ial____ <br /> No. of compartments--------s =-3----------Size- - --X-J5_.__.Liquid depth.... i------------Capacity._-/_� -- <br /> Disposal ield: Distance from nearest well;- ` _P...._Distance from f oudation.___fa._....i.Distance to nearest lot line-..-- <br /> Number <br /> ine__Number of lines_____ ____ _._ ' ----------------Length of each IAS--___ _�__ . r!"�Width of trench--------__ _�_-___- <br /> Type of filter �--Depth of filter material_____. 2T._ _---Total length---------------_____ __________----__ <br /> See a Pit: Distance to nearest well- ✓��____bistance from foundation.....�0.......Distance to nearest lot ne._-�____:.___ <br /> Number of pits___.__ r__________ ,Lining material__/?O.CK--_Size: Diameter_ 7� <br /> 1 <br /> Cesspool: Distance from nearest well_! ___,___._'Distance from foundation-._____-______ Lining aterial__.__.__��-_--____________________ <br /> I] : Size: Diameter------ I--•--------- ' •-..---be th--- ------------------------------------------------Liuid Capacity gals. <br /> Privy: JCbistance from nearest well,*------------ _-____Distance from nearest buildingi <br /> ❑ -Distance to nearest lot line----------------1-----------------------------------------------------------------••------------------------------------------•--•----------- <br /> , <br /> Remodeling and/or-repairing (describe}:--------.. . ---•---------__1----------------------------------------------------------------------------------I............I__-------- <br /> --•--.......­------------------- --•---------------•--------•-----•- <br /> 4 <br /> T: <br /> I hereby certify that I 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. <br /> { --_------ --- -----_---_----- ------r-- _ _.----(owner_and/or_Contractorl(Signed)--•--------- _ .. <br /> '2L --__ --� <br /> 0 <br /> By:.-_-------- -------=--------------- .......---------------------------------------------------- ------------------------(Title)------------•----•--------------------------- --- -- <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------1 --------------------- ------------------------------------------- DATE------�--�-- -•- � 'Z��--- <br /> REVIEWED BY - t DATE <br /> - -------- ---------------------------- <br /> BUILDINGPERMIT ISSUED........-•--•-•-•----------------I--------•----------------_-------------------------------------- DATE_------•------•---------------------------------------•----- � <br /> Alterationsand/or recommendations---------------"- ---------------------------.......-------------------------._...._..---------------------•-----•---------------------------•-------- ---- <br /> f/ - _v6. ��V��-----)- --------,f_PBC _�_�/.aVc---�..... L--r ..�HF�T�-� a----- <br /> „4 5,rs-r�M-----A __`Cti-'`�---".7]M�...- T=11'�' • ----- • : ...-t------------ ��o <br /> ;✓ -�(a _CHF �SEtP------KSS F)Tior �� f fflnrC S. -- r fry---`y--x b h'a7-,ass_awEo __,��CQ X_ <br /> . '-X?."!.3.., _E%5;.j _4I1`�npf l... 1-{ ` '' ._.. � I ._-_ZE._.c __ - -.�'t'1!:__•-CA x? �� ���. <br /> WP i-t.,- t PVF- -10 5 - ,�cc u l�-rr 1� Cats ! <br /> �l <br /> FINAL INSPECTION BY:. Date----- --------- f 7 ___63-- ---------------"r•Z: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strnei"' .......300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California = Lodi,California Manteca,California Trpcy,California <br /> l�•�f' E5 9 REVISED 8-59 2M 5-62 ATLAS r <br /> 'df <br />