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FOR OFFICE USE: <br /> -------- ------[ ------------------------------------ <br /> J.,7 <br /> ........... <br /> APPLICATION Ft- <br /> SANITATION PERMIT Permit No. <br /> (Complete in Duplicate)% <br /> ------------------------------------------------------ <br /> Date Issued ...................... <br /> This Permit Expires 1 Year From Date Issued <br /> - <br /> --------------------------------------------------- <br /> Application is hereby made to the Son 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 /> JOB ADDRESS AND LOCATION. 663--W-eat--8th,------S--t, -----------------• ------------------------------- <br /> Owner'sName--------------Lu-c-io...Ri_v_e_r_a---- ----------------------------------------------------------------------------------------------- Phone__HQ..._5-x_7_8_7_Q___ <br /> -------- ----- <br /> Address-----•--_---------------aboy's---------------------------------------------------------------------------------------------------------------------I------------------------------------------------ <br /> H 3-1269 <br /> Contractor's Name------ ftrTIC-0.1---Inc,-------------------------------------- ----- Phone-----qt ---------------...... <br /> Installation will serve: Residence a Apartment House F] Commercial [-] Trailer Court E] Motel [3 Other ❑ <br /> Number of living units: Number of bedrooms __3__' Number of baths ---;k-- Lot size _____IMI- 9.0.1_------------------------- <br /> • Water.Supply: Public system [?5 Community system El Private E] Depth to Water Table 33- ft. <br /> Character of soil to a depth of 3 feet: -Sand E] Gravel [j Sandy Loam E] Clay Loam 0 Clay [] Adobe JS Hardpan E] <br /> r Previous Application Made: (If yes,date-__-___--_.-_---__-] No IN New Construction: Yes [3t No E] FHA/VA.. Yes E] . Nod] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------ <br /> ZxUtingNo. of compartments--------------------------Size--------------------------------Liquid depth-------------- ---------Capacity---:------------------- <br /> Disposal <br /> --------Capacity------------------------ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_________________ <br /> Kxl[qting Number of Pnes-----------------------------------Length of each line--------------------------------Width of trench---._.-------,--------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length____---_------.-_:________________________ <br /> nearest well-- 101 <br /> Seepage Pit: Distance to 001_________-Distance s't foundation_--- d--_______.Dist to nearest lot line---51--------- <br /> - Di ance from found 0 (1 <br /> Number of pits--------1------------Lining -material----X!941;-------Size: Diameter------n----------------Depth-29$t Max* <br /> --------------- --------- <br /> Cesspool: Distance from nearest well-_--____ -_-__--_Distance from foundation------------------- Lining material_____________________________________.Size: Diameter--------------------------------------De th---------------------------r--------------------------Liquid Capacity-------------------------_--gals. <br /> Privy. Distance from nearest well________________ ___________---__-_____-__-_Distance from nearest building---------------------------------- <br /> Distanceto nearest lot line----------------------------- ----------------- --------------------------- ----------------------------------------------- ----•-------------------•-------------------------------_­- ----------------------- --------- <br /> Remodeling and/or repairing (describe)----------------Add1ng Filter-4bed to existing system, <br /> ­------------------------------------------------- <br /> -----------­-­---------------------------------11--------------------------------------I----------------------------------------- ----------------A------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------- ------------------------------------------*------------------------------------------ ------------------------------------------------------ <br /> ---------- -------------------------------------I-------------------------------------­-----------------------A------------------------------------------------------------------------------------------------------ <br /> I hereby cerfify'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)-----------Delta Septic Tank Service,, Inc* <br /> - ------------------------------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> Perrsy Warthan Gen, Mgy�,�. <br /> By:------------------------ ---------------------------------------------------------------------------------------------------------(Title)------------------------------ ........... ... ..... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side),IP <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- ---- 416_6-ln--------------------------------------------------------------- DATE--------------/_ <br /> REVIEWED BY----------------------------------- - ­ - - - ----•• DATE_-----------------------------------------------------_--- <br /> - <br /> - <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE._--------_------­- ---------------------------- <br /> Alterations and or recommen I ions:-------------------------------- ----------- ---------_------------------- --------------------------- <br /> ------------ <br /> -------------- <br /> ---------------- -------- --- <br /> ---------------------------- --------------------------------------------------------------------------------------------------­­-------------------------------------------- <br /> ----------------------------------------- -------------- -------------- ------------------ ----------------------------------------------------I------------------------------------------------------------ <br /> ---------- -----------_-------- ......................... --- -------- ----------- ------------------------ --------------------------ate------------------------------------------------------------------------------------- <br /> -------- ------------X_q <br /> FINAL INSPECTION BY:---- . ...........—-------------------- D --- -- ------7- ---------------------------------- <br /> SAN JOAQUIN ILOCAL HEALTH DISTRICT <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 /> ES-9 REYMED M-SO F.P.03.2M 6.613 <br />