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1­_UK UWCE USE: <br /> A, <br /> -------------------------------------------------- <br /> - <br /> ------------------------ --- -------------- ------- APPLICATION FOR 'SANIT TI N PERMIT Permit No. ..... <br /> - - ------------------------_---------------- ........ (CcimpIe+eA1 ,1. <br /> ----------------- --- --------------­­- -------- This Permit Expires I Y r'FLo M Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District;for'6 permit to construct and install the work-herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549.,: <br /> JOB ADDRESS AND LOCATION_-______--4_/, 4,00--)c <br /> Owner's Name: ------------- ----------- -- Phone-------------------- <br /> 4- --------------- <br /> Address------------------- <br /> -----------I--- ----------­------------------- ---I------------------- <br /> ------------ ------ <br /> Contractor's Name______________ 4-I -.---•-----------------f— ----------------------------------------- -- --------------------­--------------------- Phone------ ----------------- <br /> Installation will serve: Residence [] Apartment House [] Commercial El Trailer Court 0 Motel E3 Other Ej <br /> Number of living units: f.___- Number of bedrooms _43--- Number of baths--------- Lot size ----- --- -------- ------- -------------------------------- <br /> Water Supply: Public system E] Community system El Private 0 Depth to Water Table ft <br /> Character of so-I] to a depth of 3 feet- Sand Gravel ❑ <br /> Sandy Loam E] Clay Loam [] Clay E] Adobe [-] Hardpan ❑ <br /> Previous Application Made: (If yes,date----------------- No E3 New Construction: Yes E] No El FHA/VA: Yes E-] No 0 <br /> 4 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i T2 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welt________________Distance from*foundation------------------ --Maferiaf ..--------.__-__---____.._---___-_-.-- r <br /> . <br /> El No. of compartments...-- ------------------ Size. <br /> ---------------------------Liquid depth- -- ------- --.....Capacity------ ---- <br /> Disposal Field: Distance from nearest well-..._.___..__.__Distance from foundation___---------------- to nearest ]of line__-.-._.____--__? <br /> ❑ Number of lines---------------------- -----------Length.of each line-, ------------------ .-.Width of french <br /> Type of filter material__ _ ------------------Depth of filter materiaL____ .----------------Total length___.--..._______-____.__.____________.__ <br /> X <br /> Seepage -Pit:" Distance to nearest well---- .___.. ........Distan(fefrom foundation__________________ Distance to nearest lot line.-_______._--..._ <br /> ❑ Number of pits... ------------------Lining material_----_.___.._......_ j 0 <br /> Size: Diameter <br /> Cesspool: Distance from nearest well ----------------Distance from foundation.--._._..._..___------------ Lining material____...---_.-________._ -------- <br /> ❑ <br /> Size: Diameter- -- ---------;-1-- ----------------Depth-------- ----- .I-----------------I----------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well--------------------------------- -------------- Distance from nearest building--------------- <br /> El Distance to nearest lot line ..----------------- - ----------- <br /> Remodeling and/or repairing '(describe) ---------12- <br /> --.01 x;, ` ------4—_ ----------- r <br /> ----------I------- <br /> -------------------••------------------ ------------- ------ -------------------------- ---------------------------- --------------------- ------------------ ------------------------------------ ------ <br /> ----40 <br /> - ----------------­----------------------------------------- --------------------------------------------------------------------_------------------------------------ <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, and rules/and regulations of the San Joaquin-Local Health District. <br /> (Signed) i <br /> f <br /> ---------------------- ------- -------- (Owner and/or Contractor <br /> .tzel _ --------- ---------------- - <br /> By:----------------------- <br /> ------------------------------------ -------------------------------- ---------------------------------------(Title)----------- ----- -------------- ------- ----- ------- <br /> (Plot plan, showing size of lot, I.ocation of system.in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED E! 114! —— -------- ---------- -------------- DATE-----�-'�--� -- - <br /> -------------------------- <br /> REVIEWED BY----------------- <br /> DATE <br /> BUILDING PERMIT ISSUED-------- -- - -------------------------------------------------------------------------------- ----------- ------------------------------------------- ---------------- <br /> --------------------- --------------------------------------------- -------------- DATE_... <br /> Alterations and/or recommendations------------------...__._.... <br /> ------------ <br /> ecornmendaiions:---------- -- -------------- -----------I---------------- <br /> ---------------------------------- ------------ --------------------......­------- ----------------------------------------- ----------- -•------- ....... <br /> ------------- <br /> --- ----------------------- ........­__...... ------------------- -------- <br /> ----------------- ------------------------------------------- -------...... ---------- <br /> '.I. ; ; --j'_------------- <br /> ------------- ------------------------------------ -----------------­­­­------- ---------------------------------------------------­----------------------------------------------__..................... ... ........ ....... -- ------------- <br /> -- ----------- --------- -------------------------- ------ ... ----------- <br /> -------------------- <br /> FINAL INSPECTION ------- ------- Date- ----.-- <br /> -------- ------------ -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E6 Haxelton Ave. 300 West Oak Street <br /> I 244ycarnore Street <br /> W - j..20,5 West 9th Soeelf <br /> Stockton,California Lodi. California anteca,California <br /> Tracy, California <br /> E.H.4 2M 1-67 Vanguard Press <br />