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FOR OFFI,C USE: <br /> l <br /> APPLICATION FOR SANITATION PERMIT Permit No. ......... .._......... <br /> --------- (Complete in Duplicate) ,.:- Date Issued .....�� /�2 <br /> ---------------------------."-""---"---".-:- - This*Permit�Ex ires1 Year From Date Issued �^ <br /> Application is hereby made to the San Joaquin Local Health District for alpermit to construct and install the work herein described. <br /> This application is made in compliance with County .Ordinance No. 549. <br /> 2 2 County Club Blvd. -- .{' <br /> -----•----------Fred_-Wt_.-Gauger _ _r: Phone-HQ i?iQ� <br /> JOB ADDRESS AND LOCATION._: --- ---------------------------•-------------------------- <br /> Owner's Name------------------ �. <br /> i <br /> Address---------------- 'SaMat <br /> Contractor's Name---`' D---DAY-: 'c,t_NIGHT__►S`'e_gtic__Tank•TService----------------------------- --- " ------- Phone.....xQ---63-841-----• 1 <br /> Installation will serve: Residence$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:3......._.Number of bedrooms -_2_-'Number of baths ______lLoi size-_n___l00.____X_ 15_ --------. <br /> Water Supply: Public system$ Community systeni ❑ Private ❑. Depth to Water.Table ft, pluX f <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel f'Sancly Loam ❑ Clay Loam�0 Clay❑' Adobe CU Hardpan ❑ <br /> } :No New Construction: Yes <br /> Precious Application Made: (if yes,;date---------___.__._ Q ❑ ;No.�"'.FHA/VA: Yes ❑ No ❑ ;_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> I <br /> (No septic tank or cesspool permitted if public sewer is available-within 200-feet.) , : <br /> Septic Tank: Distance from nearest well_...Nonq?Distance from found fion__�r0..__ Material._______(C� -Blriek <br /> -- ------------- <br /> ►9 No. of compartments____2---._----_-----�_Size�_.56rtx�6ii X._�=quid depth_ 5$1t__,Capacity--•_:00 Gals . <br /> Disposal Field: Distance from nearest well____NQM__Distance from foundation-----1Q1-------Distance to nearest lot line:_ -_ 51..... <br /> Number of lines__ tr <br /> �------•-;-•---•i-•---��----.f Length of each fine---3-Qt-�O_�,�, _t.Wldth of trench--�-- -------==-----..-------- I <br /> Type of filter m:aterial '� ")Depth of filter material____ ""`..__Total length_..._..(cam._!....................... <br />. - r <br /> Yp � �.# p • <br /> Seepage Pi}:. Distance to nearest wt311':XQll�. __--_DistanceBfrrom foundation--....0�..:_=-.D'st ��a to nearest lo} line <br /> {{�, <br /> Number of pits_---- ",2----____--Lining material....-•--•--------------Size' Dlameter_° '`r -:--°-----.Depth--------12 <br /> -••----- <br /> 1 �t��i ,. sem: .•r, 1 <br /> Cesspool: Distance from nearest well-________________Distance from foundation._._.______ ".Lining material-----------------------.------------- <br /> ❑ Size: Diameter-'> Depth ------------------------------------Liquid-Capacity----------?------------_-gals. � <br /> . „tea . -------------------- <br /> 0 <br /> ' <br /> y- .nearest buildin �'-'___________..____._. <br /> ❑ Distance to nearest dot line---------=�.•--""---------------�------- --------:;.�_-----"---�--�---------.....------------..-�------'•=----------------------------- <br /> rlv is ante from nearest we _____________________________________ <br /> _____. is ante from, <br /> Remodeling and/or repairing (describe)y_________________________________ [, <br /> ____________________ <br /> -------------t---------------------._....__.�"__=__M_t_-___.-_____-............ <br /> I ______________ k_______..__..______---___..._....._..._..___._ ______-_____.__ <br /> ------------------------ <br /> ------------------------------------------------------------.-------•-•----------------------------------- --•---•---•-----....:_1- °------------------------------ <br /> I hereby certify that I have prepared this applicatiort-and•that-the work will be done in accordance with San Joaquin County NA, <br /> ordinances, State laws, and rules end regulations of the San Joaquin Local Health District. <br /> 5i ned Th a. PkY"& NIGHT! Sep <br /> tic Tank Serepls, �uild4inis, <br /> :- <br /> ( 9 ) - -- - -------." --". k...--•e.r_ - i - -------------------------• ---- .(� $r Contractor) <br /> y• (Title). ---------------------- <br /> (Plot plan, showing size of lot, location of system in relation to et . can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED----' -".-- .4 " � DATE_. �.L--_i.-- -, I <br /> REVIEWEDBY------------------ -•----•-•-----i••------- '-------------------------------------------------------------------------- <br /> -- DATE------------------- -------.................... T <br /> BUILDING PERMIT ISSUED ---A,------- ;-------------- ------------- ...--- --- ' ....... <br /> 1 AT <br /> Alterations and/or recommendations: _• `----• ---- _�2______-1��a l -___k__a________ <br /> ------- -- --- - - <br /> --- ----------- --------------------------------------------------------------- <br /> -�............A- ----- -- -- -------------- ----------- -... <br /> . <br /> --------------------------------------------------------------...-------------- ------- ---------------------------------- ------------------------------------------------------------­* <br /> $------------------------------------ Date.-----t-R - Q G-. .._..._ <br /> FINAL INSPECTION BY:.""""C...""{( .- ""._ --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT f <br /> 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> rS 9 At V185o S-S9 yM 5-61 ATLAS , <br />