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IIcs (s.-t ri <br /> APPLICATION! FOR. SANITATION PERMIT Permit No. --- sQ-_ <br /> ( mpleta in Duplicate) <br /> Date Issued --_ 7.` <br /> Ap lical,ion is hereby made to the San Joaquin L F <br /> q Health District fora permit to construct and ' stall the work herein described. <br /> This application is made in compliance,with.Counfy#y Ordinance No. 549. <br /> �i �' <br /> JOB ADDRESS AND LOCATION-w~ -�-��+�' ; �-�—ei �CJCl���tl <br /> - -- ------------- <br /> `' <br /> Owners Name---------------- r4 GC` - �------------------------<: <br /> ------------------- ------- --------- ............ ------------ Phone <br /> Address --------------------- --- _ �_ _ G• <br /> -------- <br /> ---------------------- <br /> ---••------------- ---------I- ------------ <br /> Contractor's Name-----t--!Lr,+.1 � .�_,1 <br /> -- ----------------------------------------------- Phone---=•----------------------- -___ <br /> Installation will serve: Residencert` . Apartment House,❑` Commercial ❑ Trailer Court <br /> ❑ Motel ❑ Other ❑ � <br /> Number of livingunits:`-Z--- Number of baths --1--- Lot size -------__-� -K• -_S 7 <br /> ---- Number of bedrooms <br /> Water Supply: Publics stem Community system Q Private K Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel'❑ Sandy LoaM4 ClayLCl <br /> Previous Application Made: Yes El No El . New Construction: Yes oam Clay Adobe❑ Hardpan E] <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 � <br /> ----- --O----Distance from foundation--.--/!;?--- <br /> -_Material---No. of compartments-- _- Si <br /> -------- <br /> „ Kept - � <br /> ------ --- Capacity-- <br /> Disposal Field: Distance from nearest well <br /> -5�- L <br /> - --Distance from foundation------/�--------Distance to nearest lot line----�-_-••- <br /> TypeNumbof fit er material- _-- ,hvr. p ngth of each line_---__------ ---------- C)----------Width of french----------I <br /> --------------- epth of filter materral-_.-__-�f?.-.._-Total length-----•-------_--------_-/ZC1 <br /> Seepage Pit: Distance to nearest well _--__---------Di <br /> El 'stance from foundation..----------------- Distance to nearest lot line.... <br /> Number of pits----------------------Lining material-----------------------Size: Diameter---------D, ----------Depth _-------_------------------­.-- <br /> ❑ Size:-Diameter------------------------------ Destance from foundation--------------------Lining material--__-__ - <br /> NCesspool: Distance from nearest well----------------- pth--------------------__-- -- - •_Liquid Capacity ----- <br /> Privnce i <br /> rom 9 pacitY ----------------------- r. <br /> ❑ Distance to neareatelot1linle_________ _____ -r- ------------ -----------Distance from nearest building---------------------------- <br /> ---•-------- <br /> Remodeling and/or repairing (describe)------------------ - " <br /> ----------•---- <br /> ----------------------------------------------------------- <br /> -------- - <br /> ------------------------ ---------------------------------------I---------------------- --------•----------•----------•--------••-----------------------------•------•-------- ------------ <br /> ! 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) <br /> ------------------ ---- --------------(Owner and/or Contractor] <br /> --------------------------------------------- <br /> -------- -•----------•----------• - - Title <br /> (Plot plan, showing size of lot, location of system in relation 'to wells, buildings, etc., can be placed on reverse side). i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_.-- .--__-- <br /> - -- ----'--- -------------------•------------------- DATE---------- <br /> REVIEWED BY_----------- --------- ---------- ----- _ - - - - -- - <br /> DATE <br /> BUILDING PERMIT ISSUED--------------- <br /> .. DAT -------•-------- <br /> --- ------ <br /> Alterations a ---- <br /> -- ------------ <br /> "' g I � <br /> --------------- - <br /> V ----------- <br /> ----------------------- <br /> ------------------- -----=- <br /> ------------- ------------- ' <br /> f - - --- <br /> -- - - <br /> --------------------------------- ---------------------------------------- ---------------------------�-�- a ------------------------ -----------------------------`---- -------------- <br /> FINAL INSPECTION BY:.. _ <br /> ------- <br /> Date <br /> ---------------- <br /> ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> !30 Soufh American $free+ 300 West Oak Street 132 Sycamore Street <br /> 914 Norfh "C', Street <br /> Stock+on, California <br /> t , <br /> Lodi, California Manteca, California Tracy, California `. <br /> ES--'9 145446 ATwppp =� <br />