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APPLICATION FOR S� I •. rn1,r t . * Permit No. _._.. .�!.. <br /> ................�-------- {Complete in Duplicate) 7 Sr <br /> .................. ...... ...................._ This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIO ------....Y.1. _(5........ .................................................................................. <br /> ......._:.. <br /> Owner's Name............. . �c �G ...--•... . .. .........--.....__..--••--•- <br /> -•......•- --- Phone.................................... <br /> Address...................... .,jc•3..67-.. .............................................................._......................................................................... t <br /> Contractor's Name...... ........ _................ :................... Phone................................... <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer-Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ...... Number of bedrooms .3-- Number of baths .j..._ Lot size ...................____._ � <br /> Water Supply: Public system ❑ Community system ❑ Private epth to Water Table : ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay E3Adobe ardpan C3Previous Application Made: (If yes,dare.......... ..........I No [e New Construction.: Yes ENo L FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Na septic tank or cesspool permitted if public sewer.is available within 200 feet.) 4r°.�42L ,���� � <br /> Septic Tank: Distance from nearest well...,��.....Distance from foundation_.... Material-------�1..✓�-'' ! <br /> corn Liquid depth_ �` <br /> 1,apauty-- '- •No. om <br /> Disposal Fi Id., Distance from nearest well_.�Q--..._.Distance from foundation..../Q._r..._.Distance'to nearest lot line-................ W <br /> Number of lines------.._.�...................Length of each line_'149._�TS��Width of french__.. ........... <br /> ii � <br /> Type offilter maferialJ%_�'a5�i----------Depth of filter material.....�C1_ ..........Total length....__-.ZO..-_----_•-_----_._----. <br /> i <br /> Seepage Pit: Distance to nearest well..._/l.o..........Distance from f undation-._•.J�l_.__..DisfAnce to nearest lot line...... <br /> Number of Fits.....!-.............Lining material.�.f�--...Size: Dia meteDepth_.___...2;9..........____-_- = " <br /> Cesspool: Distance from nearest wail.................Distance from foundation..........._........Lining material...................................... A <br /> ❑ Size: Diameter.....................------.........Depth_._..... ..-------------------------------------liquid Capecity..... gals..., "l <br /> Privy: Distance from nearest well............................ .. ._Distance from nearest building...... ............................. <br /> ___._. <br /> ❑ Distance to nearest lot line...................------- ........---•----------------•-------------------_...--------.....--..-.----•-----•------------•-•----- <br /> Remodeling anc/or repairing (describe!:..............----------.....................................---•-............... ...... Y._.................-.............................. <br /> ----------------•••.............................................................................---••---........................................................--••--••-•--------••• .......................j <br /> ........................................................ .. .....................................................------- ---------_................................ � <br /> ....................................------ --------------------------------------------------------------------------............................................................................ ...-_l <br /> . <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count% .{ <br /> ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. <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......... --__.----_. . DATE......_ -- - g-------......... <br /> BY-------------------------------- ...................... .. ` ..._................. . DATE--------•--_-----•--------------•--------•-------_ <br /> BUILDING PERMIT ISSUED------•-------- > .. _.'._.�_........ DATE , <br /> Alterations and/or r commendations:........y.�, -'.. 1�,�.._. JCC%...._: , C� .-------•----------------•-••--- -.--.---- -----_---------------- <br /> �' / ' <br /> Imo• ', F_ 'y�....................-•-..................... <br /> .......................•---------.-----..---I.......... ' — - <br /> .................... <br /> ...... . <br /> ...................... _........................ ............................... ..... .......------........................................ <br /> ' <br /> FINAL INSPECTION BY............ �........... .. Date-. -........ ................ <br /> SAN JOAtQUIN LOCAL HEALTH DISTRICT , <br /> 1601 E.Hazelton Ave, 300 West Oak$treat 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Wall,California Manteca,California Tracy,California <br /> F.P-Ca. F <br /> n <br />