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FOR OFFICE USE: , �'..__.°Z- <br /> Permi} No. _--•----• <br /> -- ---- ------ ---APPLICATION FOR SANITATION POWIT �/1"l <br /> _ -� <br /> ---- - --"�"i (Complete in Duplicate] Date Issued.------• <br /> ---------- �.- <br /> -This Permit Ex fires 1 Year From Date Issued ry} <br /> --------- <br /> -_-.- -------------------- ---- --- ---- �- � Permit to construct and install'}he work herein described. <br /> Application is hereby made to the San Joaquin LocalOrHdenancDlNoc 549 - <br /> b71_ ��n��y. <br /> This ap lication is made in compliancewith County <br /> �c • <br /> JOB ADDRESS AND LOCATION___.-- * -------------------------- Phone'k -------------- <br /> -------------- <br /> Name <br /> . --------------------------------------- <br /> Owner'sPh <br /> t>7c.__ Y`v f on <br /> Address-- -- <br /> 1 -- _- ❑ Motel [], Other <br /> Phone .... <br /> Contractor's Name_.__�?dc«' Commercial ❑ Trailer _Court <br /> Installation will serve: Residence ❑ <br /> Apartment Housel❑ . i ____ <br /> f - " <br /> �. jg YEA r D IRF <br /> Number,�f living units: ___�.___ Number of bedrooms _______. Number of bth+o-V1/atepTalble �-{"�-��ft• <br /> Community system Q Private tA Dep Adobe❑ Hardpan ❑ <br /> Water Supply: Public system ` Clay Loan+ ❑ Clay❑ <br /> Gravel C3,,�Sandy Loam ❑ Y, FHA/VA: Yes ❑ No ❑ <br /> Character of soil to a depth of 3feet: Sand ❑ New Construction: Yes ❑ No ❑ <br /> Previous Application Made: (if yes,dote-__--------:--- <br /> -I No`❑ t , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitted if public sewer is avaiiablewit4lin 200 feet.] &V'e <br /> / - Material _ �- <br /> _ _Distance from foundation:_,- -•-- ,, <br /> Distance from nearest well- 4- ==- �. (a._.-______-.Capacity--f` a <br /> l Septic Tank: gt �p�(-_-x_ L Liquid,dep#h___ <br /> from nearest well - ---- <br /> p _'Di t!` Distance to nearest lot line.----- ------ 'J <br /> {y No. of tom a mes G/"�� 1ztance from foundatior _.-- ' �� <br /> Disp'o"saf�Fiel, d:I Distance ` <br /> �►�i� t 1 1 -----------Length of each l inelXldD-- - x.` Width of trench_�I--,•-------------------------- <br /> Leo <br /> :- �. <br /> umber of lines/0--------------- Total length.___,U6----------------------------- <br /> ,N <br /> Type`Lof filter material DePth._of filter-;material___ �/}- ----A <br /> ick. .� r . w <br /> Dis ante fro` yfoundation_.__•__-.--•----Distance to nearest lot line._-_____,.-----•- <br /> E . w ► . ' f ---------------------- (h <br /> Seepage Pit: Distanceo�.nea,rest well_._-_-_ ;- Size: Diameter_________________ ____-.Depth <br /> t }ante fr1m foundation:- - ------- -_Lining=+raferial_---•---------• <br /> 4 � nal----------------------- l <br /> ❑ Dumber of its_ __-- ____-_ Linin matet � � ---------- T <br /> P - <br /> Distance from nearest well--------------- Dis - Li <br /> ' - _ Liquid Capaci gals <br /> t Cesspool: °�.`- -------- tY------------------ -----•--- al <br /> # Depth-----�,..�..,—. - <br /> ❑ Size: Diameter_ -,_--.- - - f <br /> i --- --- _ - -Distancfromnearest buildin -------------------- <br /> Privy. <br /> Distance .from nearest well_ r_ ,- a._..__ " ---� ---•--•------- <br /> t <br /> / w► '+� -- <br /> f Distance to nearest lot line .. . _ � ft -----•--------------------------------- <br /> --------------• ti Remodeling and/or repairing (descibey:__._ ------------- - ..------- ---------------------------------- --•------ <br /> t -- <br /> rv__ <br /> •------ <br /> �- ' <br /> =--=---------- _ 1+ : - - -- <br /> 1 �- . <br /> Ce a_red this aK ---- on and--hat-• --- ------------- - -with <br /> • -o <br /> ---------------------------------------------------------------- <br /> -- <br /> 0 pp n .the-work will l;e•done in accordance with San Joaquin'County <br /> I hereby certify that I have p �p <br /> ordinances, State laws, and rules and regulations of the-San Joaquin t�oca[ Health`Disti+�ct. r <br /> r. ��+ �+�••_ +-� �. # F <br /> �,- --------------------(Owner and/or Contractor) <br /> (Signed) ---- ------- � <br /> . ... <br /> (Plot plan, showing size of lot, location of system to relation to wells, buildings, tC.,'can'be placed on reverse side). <br /> 1 FOR DEPARTMENT USE ONLY J'��.• <br /> �]` = - = _ DATE----S-7-14-.---( l--------------------- <br /> APPLICATION ACCEPTED BY__- ,/ ------ <br /> r REVIEWED BY `-- ---------•----------- ---- ---------=1--------- DATE -.... <br /> kDATE--------------------------------------------------- <br /> BUILDING PERMIT ISSUED-----------------------: ^-----'------------ � R -------• <br /> a: - <br /> ________ 47 <br /> __________ r <br /> Al+erations an /or recommenfdations:f:____. 4 � -- <br /> 3 .vs-%46A . <br /> newf <br /> - _--r__ ___ ---'7 ^•-'-'--- -_ ----- _-_ <br /> --•-------- ---- i " <br /> --------------- ...... "....... ....- <br /> - �� <br /> -- - -�� Date <br /> FINAL INSPECTION "BY:-----V"- "-"---- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> 130 South American Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> E9.9 Mr11 19EO 8,59 F.P.CO,2"6-50 <br />