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PERMIT permit NO. ----------- <br /> FoR OFFIC! Date issued <br /> _7 <br /> tq Duplicate) I.t!.Ued <br /> APPLICATION <br /> ------------ ... <br /> . ... .... in DU t uct and Install the Work herein i3escl <br /> ... ...... I -Yea'r From Oa 8 <br /> ---------- ifes I <br /> • ........... mit Ex -ons r <br /> .... ....4, This Pefmi Rest ROM <br /> D' f -ct for a permit to r <br /> ---- -- uin Local Healil ' is r, (ShSAYLOres re),1 Lane-------- <br /> No 549 Etoads It. of,�---- ---------------- <br /> ;,reI5 made to the San Jo County Ordinance *Kinley I ....... <br /> P lication n is made In comp <br /> Mance with n Campo------------_-----------------------------­------ .......... <br /> app fax W5;..FrenGh ......... Phone.... 465 3 <br /> This ... ..._-------------- ........I............... ............. <br /> LOCATION stone .... ...... <br /> JOB ADDRESS AND .......d Josephine....................... ----------------- .................................. <br /> (;..Uf rord an ........ ............ ........................ 466-3 _.._:-----.. <br /> e ........ .........­, t il --_-------------" phone------------ Rest or . <br /> in ................... 11iree Res Home----------........... ............................ <br /> Owner's sho4y .......... scent <br /> 1 sme 3 ..............V............I.......... tic Tank Se='°---------------- court C, mote, 0 011ebw]:6 <br /> Address---------­-­---- Da SIA! ------- <br /> Theg ........... Commercial 0 Trailer 5 kores ------------ ------- ---------------- <br /> Contractoes Name..- ------I" Apartment House Lot size ...................... <br /> i 1dence baths ....... ­ I <br /> will 01. Residence Number it. <br /> Installation :1 Number of bedrooms ....... to Water Table --C�-ity,C3 Adobe T Rt en 0 <br /> 1 t ..... C __�t <br /> Number of living u Community system 0 private 9 Depth A/VA: Yes 0 No 0 <br /> .1 ML Clay Loat�n ❑ <br /> item 0 <br /> I - Public SY, Sand C1 Gravel 0 Sandy Loam No OPL f" <br /> Water SuPPY* 11 tion- Yes <br /> soil to a el:ith of 3 feet- Now Construction: <br /> Character 04 163 #1597 ❑No 0 <br /> ji.ation Made: 0f yes,dote.................... <br /> Previous 1,PP ID SPECIFICATIONS: I 1, 200 feet-) ....... ....................... <br /> TYPE OF INSTALLATION AN 1 permitted if public sewer is available with . I Material—--------------- ity <br /> (No septic tank 6r AND <br /> Distance from foundation................. . .............Capac ----------------------- <br /> i 0 from nearest well................. .1......Liquid dep. ........... . nearest lot line...15.!...... <br /> Distance .1......Size.....................*, 201..........Distance to neari 240 .......... <br /> Tank. A- f compartments-------------*---- m joundaticip. ...... dtb f t ench 3........ <br /> Septic Nojo 601._oistance ......... 100. ............. <br /> 11 Wi 0 1 <br /> from nearest we Length of each line--..-. ---- •19 Total length-- ........ <br /> D Is ..81 Field: Distance of lines-- -------2 -------- f filter material------------ -*------- . rice to nearest lot lme..-""..........' <br /> st -g Muober i��,Vt4.c Rk Depth 0 Dista <br /> Ty�e,of filter material------ -- -- --------- foundation----------------------­. <br /> nearest well_.-.-.-"" -------- <br /> .......Depth <br /> A& ...... Distance from Size: Diameter <br /> p-j. T. Distance to ea'es . I mater;aI_--------------- ----­--------- <br /> Seepage "Is of pits-...------ Lining material---------------- Lining tv ..................ga <br /> Ntriber P Distance from f8undation------------------ <br /> ❑ .91 m nearest well.................Distance <br /> .......................... .........Liquid Capacity..._`---------.....-..--- <br /> apac i ---------- <br /> cesspool: Distance cc ........... <br /> Depth-.._ --------"._._Distance:irom nearest building--.. <br /> ------------------------------------- <br /> ............ ......... <br /> S!�e: Diameter. ------------------------- ............................. <br /> Cl 6!-1,fonce from nearest wiill�----------------------------------- .................... ------ <br /> I nearest lot line-..----- ---------------------------- AGE <br /> Privy Distance 0 AR1.DRW --------------....................................... <br /> ...................... <br /> 0 -------------11..............­­­................................................ <br /> Remodeling and/or �ep,iiinij (describe):---------------------- --- ............ <br /> ....I............................... <br /> Remo ....... <br /> _A---------------------------------------I................. ............ ......." _ ------- ------ --------*,+h s Joaquin Cc' <br /> ............................ ---------------------I--------- ........................ 1, accordance w an <br /> .......................... .................................. ...a-nd f-In-at e work- will be done <br /> Its <br /> ...cation I Health District- <br /> . <br /> .. " 'certify <br /> I---- . �. t at av, prepared this of f Joaquin Lace Contra <br /> I hereby ce , and regulations <br /> ordinances, tate jf�. s, a ul: .............. .................. ......... .. .. ..... .... . <br /> ' a4/ GJ tliQnt--S5KV1C5:........... ..... Intlel- ------------r I everse side). <br /> ------- ---- -- ------------- - --- <br /> ----- be placed on <br /> (Signeal------- in ation to wellsbuil Ings, e n <br /> 2915 0 Miner 9:1.... <br /> BY:----11-----Q . lot, location of sY em I <br /> (plot plan. Showing sizeS E ONLY <br /> FOR DEPARTMENT <br /> . .............. D^I -------—----- --_-............... <br /> DATE--------------------------------- <br /> ztz�- -----------------------------------------------------_------­ .....­­............ <br /> APPLICATION ACCErfED 5 ----- ........................................... . DATE------------------- ----- ... <br /> ------------- --------- ......... ....I.,........... <br /> REVIEWED By....I.................................. .......... ........... ........................................... ......... <br /> ---- ........ <br /> BUILDING PERMIT ISSUED------------------------- ............. ................................................................................ <br /> r recommendations:..-.-.-" <br /> .................... ...11................................ ... <br /> Alterationsand/ ......... .......................... .............................. .............................. ......... <br /> .... .... ............... <br /> ...... ....... . . ...... .... ............ <br /> .............. ....... 'p............ . . . <br /> .. ..... ...... ........ ..................... . ........... ..._.....................-.-.-.-..I...... <br /> ......... <br /> ............................. <br /> ......---------- ................................. <br /> .. <br /> . .... ....... . ... — - <br /> . Date. <br /> FINAL IMSplTION BY; <br /> SAN JOAQU-114 LOCAL- HEALTH DISTRICT 205 West 911,stlee <br /> 12 4 5y,m.re Street Tm�Y,California <br /> 300 Well Oak$1,00t c.liforria <br /> 1601 E H,jelion Ave. Lodi,California <br /> 11 <br /> S"'k,". California <br />