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.;R APPLICATION FOR SANITATION PERMIT Permit No..j.V-----•-•-•-•-• <br /> . # <br /> li <br /> (Complete in Duplicate)- Date lssued�-_I.3_ <br /> ~ r <br /> { Applica{ion is hereby Rmade to the San Joaquin Local Health District for a permit to co str t and install the work herein describe <br /> This application is made in compliance ith C unty Ordinance No. 5, IV <br /> ". -' <br /> ---------=--- <br /> JOB ADDRESS AND LOCATION-..._ -- --------- -- ------------------------..... - <br /> �. 14j - - --1�1(-�_�-�G�a �----- ----- ------------ Ph ne" y-- J__.---------- <br /> ------- ------ <br /> F ' <br /> Owners Name-------------------- <br /> ------------------- _�.a <br /> -------I.-��l------------------ <br /> Address i - �•li-�CE4. /� U-i` ------ ------- <br /> -------------- ' '4T• ------ <br /> - 1 f <br /> --------- - `- '---'----66- 2vG fv <br /> Contractor's: Name__1__0: s 7 - ,,kj `�----- ------- Phone------------------------•---------- <br /> Installation will serve: 'Residence., Apartment House ❑, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑7 <br /> ilQ.t .f <br /> Number of living units: __;--- Number of bedrooms - .. Number of baths __I` <br /> Number <br /> _--_--.--:-___ <br /> Water Supply: Publici system-[] Community system [<- Private ❑ Depth to Water Table <br /> s <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel C1Sandy Loam ElClay Loam Ele'Clay, AdobHardpan Els IL # <br /> Previous Application Made: Yes El No.K New Construction:, Yes NZ No ❑ <br /> TYPE OF INSTALLATION AND. SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} <br /> h s <br /> 1 <br /> Septic Tank: " Distance from nearest well:---' ---Distance from foun oq---1Z) -----Mate':al_�-_---____-"--.__--- __----__--------__-_ � <br /> eye No. compartments ` Size <br /> e---- x�U ---Li Liquid de th 4---- <br /> of r Capacity l4d o <br /> r , /�-----:-'---Distance to nearest lot lin <br /> e----•_ -••._-- W <br /> Disposal Field' Distance from nearest well.-.-`------_-Distance from foundation.-_-_-._ R if <br /> '} Number of lines---i Y----- -----------Length of each line---.1d0 f_�� -v--Width of trench---------y -------------- <br /> ✓`�' Type.of filter material- _ -•Depth of filter material-_-.--Z�-.------_:Total length_--.-------------- _ •------ <br /> f } v. <br /> r '.rn. u.a V:. <br /> Seepage Pit: . Distance to nearest well-.-.--"-__._--__.-- Distance from foundation--------------------Distance to nearest of kne__-_----_--___ -- <br /> Nlimber`oftpits "---------Lining material.----_-- Size: Diameter -Deptn <br /> I ..J <br /> ++� <br /> Cesspool. Distance from nearest well----------___----'Distance from foundation-----------------"-lining material-------------------------------------- <br /> Capacity-.­,: <br /> ----.----__---------------:--- al-- <br /> P <br /> #. -Liqui apac�t <br /> i = s. <br /> Size: Diameter----- ---'------ ------------------ Depth------------------------------ ---------------------- Y--'-r------------'--------9 <br /> ❑ , <br /> 1' Privy: �. Distance from nearest well----------------3--------------------------:-----Distance from nearest building------------------------------ <br /> — - ---------------------- <br /> -------------------to nearest lot line".._---.------=�--------- ---------- <br /> I <br /> = ' <br /> i ❑ Y -------- <br /> F <br /> -------------- <br /> t Remodeling and/or repairing [describe)---------------------------#-----------_------; ------------------ -------- ----- <br /> •--------------•----•--------------------------- <br /> "-__---- ""--_ -- <br /> 1 .1 <br /> __---_-•-.--••_.-•-•--------_•-----_--.-_••---------------•_-•.-.--__-_----____--_- _-_•-----•----_ -_•• _ - - -------------------_--------- <br /> --------------------------------------- <br /> ----.--- <br /> ___"..--------------------------- --- ------ 1- - _--- -____------_-__-_--------__--_-__._-_-._____-_-_-___-..____------...._..._--_._.__ .-_----__."----__---_--_.._-__----_____------_ <br /> I herebycertify A-a-t l 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 /> (Sign ---------- ---------------------------------- <br /> 'I <br /> ----------------- ; <br /> _-•---------- <br /> (Owner and/or Contractorl I <br /> ----- -------- - = --- --- =------•--------.----------••-------ITitlel------------------------= <br /> BY� ----- ----•----------• --••--- , <br /> ' (Plot plan, owing size of lot, locatio f system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 4— ------ DATE..-------,/�_�r• _311-� C- -------- ---- - <br /> APPLICATION ACCEPTED BY------------ -- - `-� <br /> ' -- D.ATE <br /> ----------------------------- <br /> ----------------------- <br /> ----------------------------------------------- <br /> ------------------ <br /> ' <br /> BUILDING PERMIT ISSUED------------------- ------------------•--=------------------•-------- ---•---- ----------tx� - DATE <br /> REVIEWED BY---------------- - -----------•------------- --- <br /> Alt rat and/or recommend tions 1s7orl( C ----t> "7�1� -------------------- <br /> ,r � <br /> . ---' ` --� -- - -------------------------- ---------------------------- ---I---- ----- --------------------------- ...-- <br /> e r �..-:_.._lam c----------lr.�(1 L0� tet"' ------ <br /> - • ' - -..-. ------------------ <br /> __ __ _ <br /> --- -- ---- -- -- ---------- --------- ----------- <br /> �` <br /> / -- <br /> =' ----------------- <br /> -------------------------------- <br /> Date <br /> ----------- --I---- <br /> FINAL- INSPECTION ------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 13D South American Street TracCalifornia <br /> Stockton, California Lodi, California Manteca, California y, <br /> FS-4-2M ; Revised W-2100 <br />