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? ✓ <br /> `---�,[/..�,� <br /> APPLICATION FOR SANITATION PERMIT Permit No. .--'a. . <br /> �"Z 0 (Complete in Duplicate) SCANNED ; f _ <br /> This Permit Expires 1 Year From Date Issued ate 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 /> •9 <br /> JOB ADDRESS AND LOCATION------------- <br /> /y 3L_-______r -_ <br /> - ------- .�-tom=_i-= ---•----------------•--- <br /> ------------------------------------------- <br /> Owner's Name �,✓rt j� <br /> ' --` -- -----•---•----•-- ------- .----- Phone___- -_ <br /> Address------- - .) <br /> ,/ -------------------._--- �'- ------•------------------------------------------------------------------------ <br /> Contractor's Name-- `' ' 1 fZ <br /> �' --- ------ Phone;O S�_rte/ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ElNumber of living units: ---- Number of bedrooms ?--Number of baths j___ Lot size ____!_L?_�?_ _ <br /> Water Supply: Public system 011�Communify system ❑ Private ❑ Depth to Water Table _ . <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [j_–Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Of New Construction: Yes ❑ No E+—FtTXA VA: Yes ❑ No ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta*,,,� Distance from nearest well.-___ -----------Distance from foundation-------------_.._ Materi _.____.al__-..._.____-.. <br /> No. of compartments- --------- - --- -----Size.--------- --------------- Liquid depth------------ Capacity- ----------- <br /> Disposal Fief ':.i, --Distance from nearest well-.....-----------Distance from foundation--------------------Distance to nearest lot line---------........ <br /> Number of lines---...........-- ------------------Length of each line-------------_----------------Width of trench.----------------___--- <br /> Type of filter material.- ------------Z--------Depth of filter material-----------------------Total length------------------------------------...... <br /> Seepage : Distance to nearest well.,,/�.Q_.__�_--_--Distance from foundation,l.�__�_---_-.-.Distance fo,nearest lot line_s_l�_�__.-._ <br /> Number of pits----.1---------------Lining material--_Y ``-J<�.---.Size: Diameter..___–�_",�r1--Depth...cr S_--------­----------- <br /> Cesspool: <br /> ------•.-----,-__-- <br /> Cespool: Distance from nearest well-------_-----_.._Distance from foundation...__. ______ _ Lining material__._... _._--_-...... <br /> Size: Diameter----- --------------------------- <br /> ----Depth------- - - - -- ---------Liquid Capacity. ----- . . . --........gals. �l <br /> Privy: Distance from nearest well------------------------------ --------Distance from nearest building <br /> d Distance to nearest lot line. <br /> 4" <br /> Remodeling and/or repairing (describe):___... ......... -- -------------- <br /> -------•--------------------------------------------------------------------------------------•-----------------------•-----------------------------------------------------------------•---------------------------- <br /> su - - ---------------- -- - - - - ----------------------------------------•-•---------------= - <br /> ----- ------------------ ----------- ----------- -- ----- --------------- - <br /> °A "ay certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, `d rules and regulation of the San Joaquin Local Health District.. <br /> (Signed)--------------------------- --,�' { wrier and/or Contract <br /> ------- p nd <br /> f-- o or <br /> Y: - •G------------(Title ---/ �_e ! <br /> (Plot plan, showing si of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY.----- --i--` R. _0--'------------------------- -------------------- ----I....__-- -.. DATE....... <br /> REVIEWEDBY------ ------ -------------------_--------- ---------------------- ---------------------------- - ----- ----------------- DATE-------------------------------- -------------------.-.-- <br /> BUILDINGPERMIT ISSUED------------- -- ----------------------------------------------------------- ------ --- - - DATE.-.--.-------------------------------------------- <br /> Alterations and/or recommendations:...._.._.. -- ----------------- - ---------------------_- ------- --- - ...... <br /> ------- . - ..------------------- ---­-------- ------------------------------------------ ----------- - - --•-----------------------------•-----•-------------------------- <br /> -------------------------•------------------ -•------------------------ -- ---------- ------------------------------------ ------------------------------------•-------------------------------------------- <br /> FINAL INSPECTIbf (�- - - a CT<)--- --- `1 Date...- f. - ......_......._.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Re,-sed 8.'59 F.P.Co. <br />