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6r � - t <br /> ` I� 3 7 7 <br /> 1 <br /> APPLICATION' FOR SANITATION PERMIT Permit No. __________________ <br /> (Complete in Duplicate} /d <br /> Date 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 with County Ordinance No. 549. <br /> k - <br /> JOB ADDRESS AND LOCATION-------VtT9-__leo. r�. ` reet mss= S _Q kli_Qti <br /> Owner's Name-------------IVY---Za, XQS',S------------------------------------------------------------------- ------- ----- __ Q <br /> ------- --�--------- - Phone---=----M !� -��---•----•--- <br /> Address------------------------ <br /> Contractor's Name----The-__-DAY__&_.NIGn-__5ep-t3C---r.[Aak_=$_-erV`ia&--------------=---------'------------ Phone__T0'___-2��---- <br /> �" <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer .Court � Motel er �;n'g;, <br /> Number of livingunits: __- _-_ Number of bedrooms __' -4'_ Number of baths _____=__ 'Lot size ❑ Othl��} <br /> t <br /> Water Supply: Public system Community system E] "Private El ' Depth to Water Table __50 ft- <br /> Character of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe DX- Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [ '_ FHA/VA: Yes ❑ No E] <br /> i TYPE OF INSTALLATION AND SPECIFICATIONS: ,d <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) <br /> r Septic Tank: Distance from nearest well----Nona-Distance from foundation._-_;W'..__Material_____tib"__B1!;LCk-------------------- <br /> No. of compartments------- ----------------- e_-- __-_ Liquid depth-----6}4-------------Capacity---_ 00OCia 3 <br /> Disposal Field: Distance from nearest well_�Ijpn@,--_.Distance trom oundation_____-_--1(�1_-Distance to nearest lot line-_:__}.51______ <br /> x Number ofjines____�i----•--------------------- Length of each line--- -0t--Width of trench-_-24f- ---------------------- <br /> Type <br /> ---------------- <br /> Type of filter materiaL__SePA'Rk___Depth of filter material___-18!.1----------Total length----------100-�_____________________ <br /> Seepage Pit: Distance�to nearest wef!___ Distance from foundation____]. 't' <br /> Nana-- --- Distance to nearest lot line____51 <br /> ' Number of pits------ -------i-----Lining material---- 0 Ck-------Size: Diameter------48ft__-----_Depth----------251.-------.------ <br /> cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material_-____---------____-______________-_ <br /> ❑ Size: Diameter ---- ------------------------------Depth------------------------------------------------------Liquid Capacity,------------------- gals. <br /> Privy: Distance from nearest well-------_------------------------------------------Distance from nearest building____---------__------------- \\ <br /> ❑ -,Distance to nearest lot line------------------------------------- <br /> -- <br /> -------------------------------------------------------I---------------------------------------- <br /> Remodeli <br /> ---------------- -----------------------------••---•------------------------- -------------- <br /> Remodeling and/or repairing (describe):--------- -----------------------------------------------------------------•- -- <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)- Tlae DAY &:NIGHT Septicank-- v -• -_-- ------ <br /> _-- ( Contractor) <br /> - - ------- <br /> By:------------------•--------------------••--------------- ----------------------- ----------------- ------ --- ---(Title)---------------------------------------------- -------------- <br /> i <br /> (Plot plan, showing size of lot, location of system in relation wells, buildings, et , can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -- DATE = r � <br /> APPLICATION ACCEPTED BY---- a C� ��-`-•-------------- ------ -- ---- --- ------ • ------ -- DATE------- �r <br /> REVIEWED BY - <br /> ----------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------- <br /> Altera#ions and/or recomenda#i <br /> ons:------------------------------------ T----------------------V------- ---- --------------------------------------------------------------------------- <br /> ------------------------3--------- !T------D--�T_H�---------�-5------------x--`l----------p-`x= �-:-----. <br /> ------------------------------------------------------------------------------------- ----------- -----------------------------------------------------------------------------------------------------•- <br /> FINAL INSPE N BY:- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street i ? 132..5ycamore Street 814 North "C" Street <br /> / <br /> Stockton, California Lodi, California f Manteca, California Tracy, California <br /> ES-9-2M Revisea 1-57 F.P.CO. <br />