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--------------------------------------------------- �� O G S' �� w --7 <br /> --- A' ICATION FOR SAN II"ATION PERI` Permit <br />---------------------------------------- --- (Complete•in Duplicate) r <br /> Date Issued <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 compliant with County Ordinance No. 544X7.11 I<Scfltolj <br /> ur " f JOB ADDRESS ANQ LOCATIO _ 1A+ `r -+�J _CzV 1. "' is' .. _. F I-UfVR <br /> Owners Name_---------- --------A---------_---_� -K V{-L------- --- -- -- h s '6 <br /> Address------ ------- �� •--� (1 � ' A�- = ; ---- ----------- <br /> r F <br /> Contractors Name............0W1Q.9�-l------------• -------------- --- --------- --••---•------------------- ---•--••---- Phone----,-. <br /> will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ !___ Number-of bedrooms'.o"Z_ Number of baths.-/----- Lot size .../.41:aemtf__�.________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private J3"pepth to Water Table _______ ft <br /> Character of soil to a depth of 3 feet- . Sand ❑ Gravel.❑ Sandy Loam r Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan <br /> — <br /> Previous Application Made: (If yes,date------------------- ) No New Construction: Yes �o [] FHA/VA: Yes-Kr'__No:❑ �` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: W <br /> (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) CSJ <br /> /0-----Materia .-CC/VCk'�;T ------- <br /> -Se tic T Distance from nearest well--------�Q Distance from-foundation______:_ __ _ <br /> p <br /> No. of compartments--------'�......--------Size_�,.X_I_�_X__�Liquid depth.____��9�__.Capacity_ _�`��_�__ <br /> Disposal Field: Distance from nearest well__-._._._._Distance from foundation__._.... ._ _ <br /> p f�_._.Qistance to nearest tat line_________________ � <br /> Number::of lines_____________f--------------- <br /> _-_ ___ -____-:__Length of each line_- ___-___._ CJ_.!__._.Width of trench_.__.I IL <br /> p�z,L} <br /> Type'of filter material----�6CK..__Depth of filter material-----/-_--_______Total length------------_/-9------------------- <br /> ._ <br /> Seepage Pit: Distance to nearest well-. 10 from foundation-----/. ........Distance to nearest lot line_____.____- r <br /> ____-_Linin material_ __ &O�----- Size: Diameter__ ___ <br /> ❑ Number of pits-------�----- g �� -------Depth------ --- <br /> Cesspool: Distance from nearest well _________________Distance from foundation___ ------ __Lining material:----------------------------------- <br /> _-_ i <br /> ElSize. Diameter- <br /> Size. ------------------ -----------Depth----------------------------- ---------------------Liquid Capacity----------------------------gals, (0 <br /> Priv Distance from nearest well-______ ----------------------- <br /> ----- from nearest building <br /> ❑ Distance to nearest lot line .--------------------------- ---------------------------------------- -----------•-----------------------------•------••---------------------1 <br /> C. <br /> Remodeling and/or repairing (describe)------------------------------------ ------------•-•-------- -----•---••---•-------------•-•--------------------......_........--------..---------------- <br /> ---•-----._............:.....••.....•-----.:......._---- -------- -. -•----- -••-----••---- -----------------------------------------------------------•---•-•--------•=--••------••--------------------------•-••------- <br /> -----------------------------------------------------------•------•------•---------------•---•----•--------•---•----------------------------•------------------ -------- ................-....------------------------------ 26 <br /> -------------------------------------------------------------------------------------------------------------------------------------------------- -----•----------------------------------.--------- ---•----------- <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 411aws. d r s and egulations of the San Joaquin Local Health District. <br /> v <br /> (Signed) ------ -------------------- ------- --- - -----------------(Owner and/or Contractor] -� <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----._T --------- ------------- --------------------------------------- DATE-------- <br /> ------------------- <br /> REVIEWEDBY--------------------------------------------------------------=----------­­--- -------- -------------------------------------- DATE------------------••-----------.._.. <br /> BUILDING PERMIT ISSUED---------- ------------------------------------------------------------------- ------ DATE---------------- <br /> ------------------------------------------- <br /> Alterations and/or recommendations------------------------------------------------------------------•------------------------------------•--------- ... -------------- <br /> FINAL INSP ----- Date --------------- ----�..'. y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9tH Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />