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APPLICATION FOR SANITATION PERMIT Permit No. .-732 S_.... <br /> (Complete in Duplicate) _J <br /> -n 1�1� � Date Issued <br /> TTS`" d <br /> e"Applica4-ion 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 /> E L.D o,ems o ST - r <br /> JOB ADDRESS AND LOCATI I'.. t'l-V <br /> --- ------50-------� ------�-� � - --------------- <br /> Owner's Name------------- --------- -------- - - -- ---------------------- ---------- Phone.-----------------------------_-- <br /> --- <br /> kms - --- - - -- - ----- $1----s• ------•-----------•--- --- ...... <br /> Address y � yL -Y'kne---------------------------------- <br /> Contractor's Name--------- •• --- --- ------- <br /> s! <br /> Installation will serve: Residence 0—KpPartment Ho se ElCommercial El Trailer Court E] Mote[ E] Other E]Number of living unitsi"1-- lVumber of bedrooml-*&-number of baths size ________ ______________ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Asft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adobe42-1:#ardpan <br /> Previous Application Made: Yes ❑ No ® New Construction: Yes ET—_1`o ❑ <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_,_��._Qistance from founjAfionr_ ...___.-bDistance <br /> t r`I_P -----Liquid ---- P Y No, of com artments_._...."�� _._.__Size__ Ca acit ___ rDisposal Field: Distance from nearest well Distance from foundation /Yto nearest lot <br /> Number of lines----------- ______________Length of each line______ _ _(�_-___. Width of trench._ <br /> Type of filter material-107,. _ �� __Depth of finer material.._.. __. __ Total length � ________________________ <br /> `. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________.Distance to nearest lot line.__-__..________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----:---------:-------Depth--------------------------------- <br /> Cesspool: Distance from nearest well________________Distance from foundation-----.--------------Lining material--------.---------- ._____'_______ F <br /> ❑ Size: Diameter--_.----- --------------------------Depth----------------------------------------------------Liquid Capacity----------------- --- ------gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building-------------------------------------._._, <br /> ❑ Distance to nearest lot line----------------------------•------------------------------------------------------------------------------------------- <br /> Y------------------ <br /> Remodeling and/or repairing (describe):_._._ ._ _Q__ _,... . . ..__.. ` _. - �.__ _• _ <br /> ---------------•-------•--•-------- ---------------- _ h` - -• -------- -r=--------------------------------------•---------•--------------- <br /> - <br /> r ( ------------ � J _-----•--------------------------------------------------•---- <br /> ----------- ----------------------------------------- --------- -----------------------------•-------- - ------------------•---------------------•------------------ <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State and rules *Arch f4tf the San Joa Local Heal h District. <br /> NIGSeptic Tank Service <br /> (Signed).... -- --------------------------- (Owner. and/or Contractor) <br /> g ---1206-So-.1 1ttior rdo Z: a <br /> --- -- ----- <br /> By:_.__---------=--------------------------49-SCtan,,_Calif,----------------------------------------.;---------------------(Title)------ ------- <br /> (Plot plan, showing size of lot. location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> o - <br /> � t <br /> APPLICATION ACCEPTED BY -_ DATE ,-- •------------------------------------------------ <br /> REVIEWED BY----------------------------- ...{� <br /> ------ ----------------------------------------------------------- -----. DATE--�-- ----------- <br /> BUILDING PERMIT ISSUED--------- ------------- ------------------------------------------------------ DATES - --- <br /> Alterations and/or recommendations---------------------------------------------------- --------------- ----- �- r_--� ` <br /> '- :t - : _ _ ="`s!"' "' �"� ----t'�--- ---- t' __ " <br /> - . <br /> -- - --- ? :.. ----------- t <br /> '-: <br /> --------- -------------- <br /> F I N A <br /> -- --------FINAL iNSPECTfON :----- Date--------------------------------- -------------- ----------------------------- <br /> SAN <br /> --------------------- -- <br /> SAN JOAQ N LOCAL HEALTH DISTRICT <br /> 130 South Americen Street 300 West Oak Street 132 Sycamore Street- 814 North "C" Street <br /> r <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> N i <br /> E5-9-2M 185446 arw000 ,z-sa .01 <br /> C � <br /> 4 <br />