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K FOR,OFFICE-USE: --� <br /> 3 0 i .►' <br /> 9. a--bs ------------3------- <br /> ------ - ------ ----------III, APPLICATION'-�POR SANITATION PERMIT Permit No. <br /> � -- (Complete in `Duplicate) Date Issued <br /> s <br /> -_--- --------- ---- ------------------------------��-- This Permit Expires I Year From Data 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 wi County Ordina ce No. 549. <br /> !II , <br /> JOB ADDRESS AND CATION - - "• <br /> -4r�---------------- ------•-------------------•------------ <br /> y - - Q1 <br /> ------------ --Owner's Name.____.. Phone <br /> AddressI;if -- ---- ��1�2,.r--------------------------------------------------------------------- <br /> Contractor's Name---------------- - - - -------------------------------- ------ ----•-------•----------•------------ Phone----------------------------------- <br /> 11 <br /> will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />"---`^+—�-Numberof.living <br /> units <br /> � Nu ber of bedrooms__ Number of baths _/--- Lot size /- -49'I?__.�`. --——--—-------------- <br /> i <br /> Water Supply: Public system Community_system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth' f 3 feet: Sand ❑ Gravel 0 Sendy Loam ❑ Clay Loa-tri❑ Clay ❑ Adobe Hardpan ❑ 't <br /> Previous Application Made: 'Ip(lf yes,date--------------------) No New Construction: Yes ®/1Vo ❑ FHA/VA: Yes_ Vo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T Disfancelfrom nearest well-----.-----Distance from foundation_ v__.---_._ Material____ /4_ <br /> No. of c mpartments_.__ ...__._____Size__�X�_____-___Liquid cl �th_____!� --_.Capacity_____k4kD--/_ <br /> Disposal F' "''� #@istm`ar`ce' !Com nearest we11.... - Distance from foundation_f-__ ____.Distance to nearest lot l ne-__- ________ <br /> Nuer iflines_____ /---- ....Length.of each line__74-4-_7-6------.Width of trench D f--- ------------------- <br /> Type of filter in'aterial �Z "fi-Depth Of {filter material____ -e--� Total length- r <br /> -----� T <br /> 9 +��' <br /> Seepage Distance2o nearest weli____--_____-Distance m oundation---/.0_...___.Distance to nearest lot line_ __._ <br /> Number'I�f its'' ' - ��� <br /> _._A'�Einin"rmaterial___________. _ .__ _.Size: Diameter__ <br /> � p ��--,a- � g . - - �„�•3---------.Depth- [� <br /> p ..� .� ( j <br /> is -'- ------------------Lining material---- -------------------------------- <br /> Size: Diameter______________ ------------------- <br /> Liquid Capacity-...___._______ <br /> �•C�esaool: fance fio�m nearest we ------ ---Depth ce from foundation- _ __._____ __gals. <br /> ° Privy: Distancelfrom nearest well_______________..._.____________..._____.._....._Disfance from nearestbuilding_____________._______________-------- -. i <br /> Distance:io nearest lot line--- <br /> ❑ - _ .4.- ----- ---- <br /> ------------ <br /> Remodelin and/or re airin describe : __ _ } --- <br /> 9 • p gel-_ �P./ T� -._-_- : <br /> --•------------------------------------ �+ <br /> 1111 l +` <br /> ------------------------------------------ --------- ----------•------------------------------------------------------ t = <br /> I hereby certify that I haw epared this application and that the work will be done.,in accordance with San Joaquin County <br /> ordinances, State is s and ru s regulations of the San Joaquin Local'l;lealth District. r <br /> (Signed)--------- ----------- ----- --- - -- ----------------------------------------------------- ------------- ----- -(Owner and/or Contractor) <br /> BY --------------� - ----- - - -----------------------------------(Title)---- <br /> (Piot plan, showing size of loft ca+ion of system in relation to a Is, buildings, etc., can be placed on reverse side). <br /> `` FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ _ .__..._ __________________ _ �� �?-._-_ <br /> - ---- ----------------•---- ------------------ DATE--- ------------------ <br /> REVIEWEDBY-----------------------��'-------------- --- -- ------ ------- ------------- ------------------------------------. ----- DATE------------- <br /> BUILDING PERMIT ISSUED- -------------------------------------------------------------------------- DATE--------- -------------------- <br /> Alterations and/or recommendations: 0 <br /> --------- <br /> -------------------------- ZA .. <br /> / 4� �-----¢--------/--------- ----------- -•---------------------------------------------- ------------------------ <br /> T / <br /> -- ----._.._.. ------_ .'` - -_ mac `FINAL INSPECTION BY:-- ----------------d0---- `�~"`�o <br /> ---------- --------------- Date----- )- ---------------------------------------------- <br /> l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Naielton AYs 300 West Oak'Street _124.Sycemore3lret ZOS West 9th Street + <br /> --�- + k rx; U i <br /> Stockton,California Lodi,California � , MantecS,California Tracy,California <br /> F.F CO. <br /> 'I � a <br />