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�✓ FOR OFFICE SE: <br />� z <br />TION FOR SANITATION PERMIT Permit 'No. <br />--------------- (Complete in Duplicatel Date Issued."----------`---- <br />----------------------------------------- D t 1 ' ed <br />This Permit Expires .I Year From a e ssu <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. e F <br />--------------------------------------- -------------- <br />Z <br />JOB ADDRESS AND�LC?ATIO��­_--� - - - ---------y Phone.Owners Name--- <br />Address <br />ame--_- <br />Address--- l` % 1 ... 1-••----------- ---------- ----- <br />�C_ Phone .__.._...... <br />.---•--- <br />.� -- <br />Contractor's Name ---- <br />Installation will serve: Residence Apartment House El Commercial F] Trailer Court [3. Motel 13Other ❑ <br />Number of bedrooms_. Number of baths ,� Lot 'size .,----�•• <br />Number of living units: ,------------------------ <br />y Y O P �( C) ft <br />Water Supply: Public system Communit s stem Private ❑ Depth to Water Table - Adobe,{ Hardpan ❑ <br />Character of soil to a "depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam C3 Clay Loam❑ Clay ❑FMA/VA: Yes ❑ No <br />Previous Application Made: (If yes,date------------- <br />j No New Construction : Yes No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or.cesspool permitted if public sewer is available wi+hin 200 eat. . -- <br />�- Material--------�---------•------•-•--••------•----.... <br />Septic Tank:. Distance from nearest well ------ ----------- Distance from foundation ------ .-------- - <br />❑ No. of compartments----------------------Size----------------------------:.._Liquid depth--•---------------- ;----1Capacity... <br />Dis osal„ Field: _Distance from nearest well :----".".Distance from foundation--------------- 11 -------------------------- <br />to nearest lot line ---.---..__-----. <br />p Number of-lines'_1-------------------------� Length .of each line --------•----------------!--Width of trench. ---_-------- <br />❑Type of filter mate -------------------------- <br />pe mate�isl? __________------ -, 4:'' """"' <br />Total -----.- <br />... • �I Distanl a to <br />-g <br />lot, lin <br />! ..., i �~ <br />Seepage Pit: Distance`to nearest well r,.�1_.._-_Distance fro foundation" . ----- <br />�y e <br />Number <br />of;pits--------- -----Lining material ---.size: DismeV—ter .-s�i---pthC_. <br />Cesspool: Distance from nearest well_ --"-"-_"--_-_-_.Distance from fou41. <br />nda#ion__---_----"-._"-___.Cinirig material "-----"----___"-__""--_..-------- <br />Cesspool: <br />__._. <br />----De th------------------------•---------------------- ---- Liquid Capacity <br />gals. <br />❑ Size: Diameter p -tea <br />i -----Distance from nearest building'-- ------------------ ----------------- \ <br />Privy:tDistance from nearest well _.. - <br />w _ <br />Distaa"ncb to ne`a�es+'lot line-__" ------ ---------------------- r <br />i f r <br />-_...._- <br />Remodeling and/or repairing (describe]: - =-------------------------- - <br />----------------------------- <br />---------- - <br />--------------------------------------- _ .'a--------------- <br />f'---------- <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 />rr a i <br />/ n r Contr <br />�F�..r �lr� t-..--------"----------------------------- <br />(Signed')ne a d/o ac#or) <br />-41�- ---- 3 <br />:� i --. g ------------------(Title)-----: © .--- -- <br />Piot plan. showingsize of lof, location of system inrelationto wells,, buildings, etc., can 6e laced on reverse s dej• %v <br />r � <br />FOR DEPARTMENT USE ONLY <br />------------------------------ DATE-----."-�_(p"1------------------------- <br />------------------- <br />APPLICATION ACCEPTED BY �� :.� - DATE <br />REVIEWEDBY------------- ------------------------------------------- ----------------------------------------- <br />BU I LD1 NG PERMIT ISSUED -----------------•------- - ; DATE <br />Alterations and/or recommendations:-- `_- c_ - --- "=--s#•----"---- , --- `-:~.._ X4.------------------- <br />...- ----------- <br />FINAL INSPECTION BY - �"--.. Date - ' �� - <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />'1, <br />130 South American Street 300 Woo Oak Street `� - 124 Sycamore Street 205 West 9th Street <br />Stockton, California Lodi, California Nlariteca, California, S. Tracy, California <br />E5.9 FEVI9E0 9-54 F.P.CO. 2M 6.60 <br />