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Vr <br /> 0 f Permit No. <br /> LIGATION FOR SANITATION PEF�T .�. . 3 <br /> �1 (Complete in Duplicate) Date Issued _.V3�.�ra <br /> V' 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 /> JOB ADDRESS AND LLOCATION... c7�---/ - ---- ---------------------------------------------------------------- <br /> ---------------- <br /> --------•-----•----------•------ <br /> Owner's Name...... `.e.---.I�.................................. - ...... .......-- Phone.---- - <br /> y -� <br /> Address.-----------'�......... ..... --- - ---- -- <br /> Contractor's Name..--'--'------ --_--------- -----------j-------------- -- ----f Phone.................................. <br /> Installation will serve: Residence W'-�Apartment House ❑ Commercial ❑ Trailer Court ❑,�jM�otel ❑ [:]Other <br /> Number of living uni#s: ..t.- Number of bedrooms %Y-. Number of baths .Z.: Lot size -Tw �X.r�•Qfl <br /> Water Supply: Public system ❑ Community system [I � <br /> Private Uepth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay kbam ❑ Clay ❑ Adobe lardpan ❑ <br /> Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No Va-'FHA/VA: Yes ❑ No 2+ ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspV[ r itttted if public sewer is available within 200 feet.) <br /> Se tic Ta - / Distanc&Jr m nearVwell_..........._..Distance from foundation...._...:..._.....Material._........................_......_......._... <br /> No. of co�paktments Size - Liquid depth - a aci <br /> rA p . T�� p fi <br /> DW s I Field: istance from riarest well--- Distance from founda#son_-Aso......rA to crest lot line...4......_.. <br /> `C / fA umber of lines------_�..-.f..._.--.--..._- en th of each line----_ � ...6Vidth of trench_-R. . �� <br /> lC XL 1 9 - - <br /> Type of filter material. RifDopth of filter material-.-- Q--.--------To+al length-.--...a�a`�LLN/------ <br /> Seepage Pit: Distance to nearest well_ Q.Q..�-.Distance f om foundat n-.isr.A!*. .D,�jj's,t,��n; to nearest to lines..�X.�. <br /> Q/ Number•of-pits.-. .-..---- Lining material-_X196ese Deme#er.fV( .............Depth.__., _..--_-...... <br /> Cesspool: Distance from nearest well.................Distance from foundatio .......--..........Lining material.......---_-.----.----.-...__..... <br /> ❑ Size: Diameter-------------------------------------Dept h............----------------=--------- ----.Liquid Capacity..---------------------_gals. l0 <br /> ` Privy: Distance from nearest well.................................................Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line - ----------'----------------------------- <br /> _::---•-------------------------------------------------- <br /> Remodeling and/or repairing (describe):--- .- �, - - ---------------------------------- - -------- <br /> - .....................'------------------------------------------ <br /> - -----------------------------------•---------------`-------------------------------------------------------------------------------•- _------------------------------ - ------- <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 laws, nd rules andpegulations of the San Joaquin Local Health District. <br /> (Signed)--------- ---'/"-."'�`- ----- __....------- -- - --- - --.'(9wnei`'a uI,4w Contractor) <br /> --- ---------- ---------- --- ------ <br /> By:.......................-.........----- - -- -""C --------------(T'i#le)-----Aa ---- ----------. .._ <br /> (Plot plan, showing size of lot, location of in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOP,DEPARTMENT USE ONLY ---i <br /> APPLICATION ACCEPTED BY.......... '------------------------------__-------- ---- DATE----40 ) J ------------------- <br /> LREVIEWED BY-----_---------_-------------------------------------------------------_------------------------------------........ DATE----_-----------• ---------------•---_---___.... <br /> BUILDINGPERMIT ISSUED...................................................-......---------------------------------- ------ <br /> L ------------P--l-r----..----- p TH --------------- ,.K.. ---- --. '1- --_ _ DATE-----------------_--.-.•---._---_--------------------_------ <br /> Alterations and/or recommendations . :N ...TI-RIAn 1 <br /> -------f---; - -------------------------------------------------------------------------- <br /> ......-..................-- - ------------............-... ----........-------------------- <br /> ------- ------­-__-.-_-_--"7 <br /> ---- l------o <br /> ------------ ----------------------_---- --_-- <br /> --.-.-_-.- <br /> .-.- <br /> - -- - --.. -----------------------------------------.. _...---------------------------------------------------------- <br /> - ---------------- - ----= . J _ <br /> FINAL INSPECTIOR - ( /-°WtIC!- Date. . -- --- .. ------ . <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> L 130 South American Street 300 West Oak Street�i V; Sy.e•••��',,&, Sfreef _ 814 North "C" Street <br /> Stockton, California Lodi, California ManteGe, Lfornia Tracy, California <br /> L ES-9-4M Revlseo 1-57 F.P.M <br />