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APPLICATION POR SAN T�N PERMIT` Permit No. -------- '•-- <br /> (Complete`inQQu�alicate) � <br /> Date Issued .._-_--.__f-.._..... <br /> Application is hereby made to'the San Joaquin Local Health District for c permit to construct and iiistgll"the work herein described. <br /> This application is made in'compliance'with CountyAa <br /> inance No. 549. • _ <br /> JOB ADDRESS AND LO ATION... ___/'�_ " <br /> = <br /> - - ----------------------------------------•1111-•1111----•1111-1111-• ---1111-................... <br /> -" <br /> Owner's Name...... • ' <br /> t <br /> ...............•--1111-- ............... -- -- -- <br /> �, .,, ..... � ._ - .__. ,�- ---111..........-.-._ a-1111-- �.,... . . --1111-. _................. <br /> - . •----- . ..... -- ......................................................................................_ <br /> • .. .... . ...:. one.1111-- -•--- <br /> Contractor's Name-•• '- a : } <br /> ................ ... Phone-_................................ <br /> Installation will serve: Reside ce Apartment House ❑ Commercial ❑• Trailer Court4-*.:*.,. <br /> tel ❑ ther <br /> 1 .+ , <br /> Number of living units: _!____ Number of bedrooms _2.. Number baths I_ Lot sizeWater Supply:. Public system ❑ Community system 0 'Priv�e �pth to'Water Tablet. <br /> .`. • <br /> Character of soil;to a depth o: 3 feet:�'Sand Gravel Q Sandy Lo m - Clay Loam ❑ Cie r❑ Adobe Hardpan ❑ <br /> Previous Application Made: des ❑ No'• '. New Construction: Yes' No ❑ FHA/VAI Yes. No <br /> TYPE:OF INSTALLATION AND SPECIFICATIONS: }`� <br /> (No septic:tank or'cess6ol. ermitted if public sewer is available tithin 200 feet.) t r <br /> Septic nk: Distance from:nearest well:___._.., t Distce from foundation.:.:....... :.:...Mater el_�_-._-.-_______. .,.__.::_...._.••_, <br /> No. of compartirte s............. <br /> f --------------- ------Liquid dep h............ ...... °Pfacity----------- <br /> Dispos I Fie Distance from nearest-wellil 5 o <br /> tanee frm;fa�datio I ..... ista p4 ear8srlo rlirt• :� / <br /> Number of lines,_`.*.:_ s';+ :Length of each fine._.; _._ Width�o re C4..... '✓G� --___-- <br /> fo . <br /> Type of filter maters epth of filter material U -•-Total ength -k -y/ ��` ' <br /> Seepage Pit:, Distance to.nee rest'well ..._.................Distance from foundation....._.___"' :W.Distan a to nearest lot <br /> E] Number of-pits- s ..........Lining material--••--•--.----t--....Size:'DiametAr.:..._......... -------Depth............................ <br /> • Cesspool: Distance from nearest:well:'................Distance from:foundation------------ .Linifig aterial-.:___........_._._.... -------- <br /> 7_1 Size: Diameter---•---t::Y 1: `Depth. = =....-------------------------_L±qui� Capacity --------- --...gals. <br /> t <br /> Privy:` Distance from nearest well_________________________________________________Distance from nearest ilding_:__.._-_•_._............... <br /> ❑ Distance to nearest-lot- - ------------_...._ - - <br /> I �R modeling a d/or repmiri ( <br /> s ri��:� ----,-- - ----------------------- <br /> - •---••--1 111-:--•--•----:1111--1111--•.............-. F-1.111.:...1111•=•- ---------- <br /> 0 <br /> •---•1111 �..r <br /> p <br /> ----- ••-- <br /> •--- - <br /> -• •--- - ^ter <br /> _ - r -- --•---1111-- ,. •--- - . ---- <br /> ----•----------------•---. ------ -•------------•----- •--------- --------.-•---•--•-------•-••-•= =_...................... <br /> ! hereby certif t l have prepe;ed-this•application and that the work will be done-in accordance with San-Joaquin Cy <br /> ount <br /> ordinances, S5Ps,-Ax rules a r gulations of the San Joaquin Local Health District. r <br /> {Signed - �- --•-•--- -------------------------- .................. ..................................._(Owner and/or Confractoir] <br /> BY: .......--...---------------------------------------'.... .... (Title) -..w::�a' � <br /> (Plot Plan, showing size of lot, location of system in.relation to wells; buildings, etc., can be placed on reverse side). 4 <br /> FOR DEPARTMENT.-USE ONLY' r <br /> APPLICATION ACCEPTED BY :. -------­--­------------------ ATEA=_ {• ` <br /> -•--••1111•---1111-- �----•1111-•--.: .•------ <br /> D - - ' <br /> REVIEWED BY- J. DATE..--------------••..-•- ---=------ <br /> -------------------- <br /> BUILDING PERMIT ISSUED..------------------------------------------------•........._--•--------•--••••� DATE.- <br /> Alter <br /> ATE <br /> c •------------i---• r" <br /> Alterations and/or,recommendations:...............:.:........:. <br /> 1111• ----- <br /> ..............•--•1......--••• -------------•1111-...................... <br /> •_____.•__•_.__.._•-___._.-••.....•...............................•..-_--__:..............•......•••..--•.._.:......................._.........._._-_..__•-_......_.__..:....:.............._........__... <br /> a <br /> . ___________________________________________________________________________________________________________________________________________••..__..__.....__._..._._...._....._ <br /> .. <br /> -------------------------------------------------------------. -....1-••---:- .-•-1111-.• 111.1-•---•---•-•-•--•--•-- <br /> --•• ---- <br /> r <br /> 1 � <br /> • FINAL INSPECTION BY:::. Date.._ �_(.a�__ 'r._. _.— <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 SouA American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M . Revises 1.57 FY.CO. <br />