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J41----------—------d-------- -- ............. <br /> ------------------ ----------------------------- -------- Permit No. -3 <br /> APPLICATION FOR PERMIT .......---------- <br /> ----------- --------------------------------------------- (Complete in Duplicate) jl <br /> ---------------------------------------------------- '.4 ThisP rmit Expires I Ye' Date Issued --- <br /> re ar From Date Issued <br /> Applica-f-ion 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 LOCATION-_______2.19, 5 <br /> Owner's Name_...__.._Evjar_i_s_t_o.._,6 I <br /> ------------------------------------------------- --------------------------------------- Phone.H ---- <br /> " 6924 <br /> Aciclress___`......... <br /> .4 -------------------------------------------------------------------------------------------- <br /> Contractor's Name-----------__--------------Di2ta.-S-ept-i c..Tuak__65ery i_c.e.....Inc........................ <br /> Installation will serve: 'Residencd Ei iArartment House Ej Commercial E] Trai.ler Court E] Motel C] Other .El <br /> Number of living units- Number of bedrooms ---R__ Number of baths Lot.,i... .... ---------X-125--------------- --------------- <br /> --- -- <br /> Water. Supply; Public system KI Community system E] Private E] Depth to Water Table -----4,1t. <br /> Character of soil to a,depth of 3 feet: 'Sand Ej Gravel [] Sandy Loam E] Clay Loam [] Clay 0 Adobe Q Hardpan ❑ <br /> Previous Application Made: (If yes,date----------- ------] No Z New Construction:. Yes Lg No F PHA/VA: Y- E] No a] <br /> Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffedjf public sewer is available within 200.feet.) <br /> Septic Tank: Distance from nearest well______.__-_____Distance from foundation--------------------Material---------------------------------------________- <br /> ExisUng No. of compartmen'-fs------------------!--------;Size----------------------------------Liquid clep�k--------------------------Capacity----_----------------- <br /> Disposal Field: Distance from nearest well_________________Distance from fo._U6daf;on--------------------Distance to nearest lot line...-.___.___..... <br /> NxisCing Number of lines-.-.--------------------------------Length of each line-.----------------------. .Width of trench.-------------_------.-----_------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length___-_________._-_. -.___________-.__--_ <br /> Seepage Pit: Distance to nearest well----7ZD------------Distance from foundation------0_1------ Distance to nearest lot 1-------- <br /> Nu i mber of pits----------1-----_----Lining material---raok_:-----Size: Diameter__-_.._.�3 ---Depth-----25 ? M=. ____ u\___--------- ------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-..-:--------------Lining�material-------------- ------------------- <br /> 0 Size: Diameter-- ----- ----------------------------Depth-.----_--------------------------------------------Liquid Capacity------------------------I...gals. <br /> Privy: Distance from nearest well------------------------------------------------1__Distance from nearest building---I------1-------------------------- <br /> F-I Distance to nearest lo't line-- --------------------I------------ ____ . - - I <br /> --------------------------------------------- ------------ ----------------------------------- <br /> Remodeling aril/or repairing '(describe):'—'-:--addi-ng---ZUt qr.7,66d---to exing..Ay�pAgN <br /> .... .....is...t....... -----­-------------- -----------•---•--- <br /> 1 <br /> ------------------ <br /> --------------------------- ......I---------------------I--------------:----------------------------------------------------- ----------------------------------------- <br /> ---------- ---•---•----------------------------------------- ------ -----------------------••-------------------------=----- ------------------------------------------------------------------------------- <br /> ------------------------ -------------------------6--------------------------------------------------------------------------------------ff--------------------------------------- <br /> -------------------------------------------- <br /> I hereby certify that I ha4e 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 /> (Signed)---------- T n <br /> ---------------------------------------------------------------(Owner and/or Contractor) <br /> By:------------------Perry---Q Wal-than Gen. r. <br /> ­_. - --------------------------------------------------------------------- ---(Title)---------------------99------------- ..................... <br /> (Plot. plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 4. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ ----------------- <br /> -- ---------------------------- ---—----------------- DATE-------- ------6_ <br /> -- 1_ <br /> REVIEWED BY------- -------- ' I <br /> -- -------------------------------------------------------------------------------- --I---------------------- DATE-------------------------------- <br /> BUILDING"PERMIT ISSUED--------------------------------------------------- <br /> -------------------------- -------------------_-- DATE-------------------------- <br /> Alterations and/or recommendaf ions::---- ------------------------ <br /> --------------- --------- ------------- ----------------------- ------------------------------------ <br /> ------------------------------ --i A;t " <br /> - - --------------------------------------------------------------------- <br /> - ----- ------�r 4- <br /> ---------- -::,.L5 <br /> (24- 4- ------- --- -- <br /> --------------------- <br /> --------------------------------------------------------- ------- <br /> ------------------------------------------------------------ ----------------------------------------------------------------------------------- ------------- <br /> ------------------------------------ -------I------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- <br /> . % <br /> FINAL INSPECTION BY.-_f,..._6........ Date------ ... <br /> - <br /> -- ------ -- . . - C�/ - I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> E6-1 REVIDED 0-59 F.F.00.2M 6-6n <br />