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FOR OFFICE USE: <br /> ----------------- ---------------------------------------- r <br /> APPLICATION FOR SANITATION PERMIT Permit No. . ...2422 .. <br /> ------------ _0--------------------------- (Complete in DupliFafe) Date Issued ..... ... <br /> ------------------------------------------------ ------- I This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Sari Joaquin Local Health District foria permit to construct and install the work herein d C'ribe�" <br /> This application is made,in compliance.with County Ordinance No. 549.' <br /> kr-? RVY 7-// -.1-1 . <br /> JOB ADDRESS AND LOCATION...... .......................................................... ....... .....*411:36,c: <br /> . ........ ....Z.0..... <br /> Owner's Name......... . ....... <br /> -.A 4ens -------------- ------------------------ Phone--- <br /> 4' ................... ......................................... <br /> Address----------------------#`:Z .................................... . ............................................... <br /> Contractor's Name........ .......... ......................i................................................... Phone... <br /> Installation will serve: Residence 13""'Apartment House [] Commercial [-] Trailer Court E] Motel [j Other <br /> Number of living units: -1... Number of bedrooms ...%--Number of baths J.... Lot size .......1-010-4-A4 --------------------------- <br /> Water Supply: Public system [I Community system C] Private Depth to Water Table 315�ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 171 ' Sandy Loam LK Clay Loam D9 Clay 0 Adobe 0 i-lardpan <br /> Previous Application Made: (If yes,date--------- I No Ug New Construct ion: Yes [:] No 10 FH4/VA: Yes NoK <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> iSt ....IA'? ....Material------- ---------- <br /> Septic T nk: Distance fron� nearest well---14V..-D ance I from foundation .14 1 <br /> bg No. of compartments��........!!-�---------Size-si�.. Liquid deptj Capacity------ <br /> Disposal Field: Distance from nearest well-/Aft.1---Distance fror� foundation......ZP........Distance to nearest lot line......�,7....... <br /> Number of lines-------------J........ ---------length of each line....... ----------Width of trench.... ............. <br /> of.filir <br /> Type of filter material-22--v &�-------Depth er material......./9---"-.--Total length..................... ................. <br /> Seepage Pit- Distance to nearest well---- i s- V% <br /> Distance from foundation.....ZD.�.....Distance to nearest lot line................. <br /> Number of pits......../------------Lining material.;;2,6Z.-4=J,".Size: Diameter----,,-:S-d-r.......Depth-------------26---------------- <br /> Cesspool: Distance from nearest well-----------------Distance frok �punclation------------------Lining material------------------------------------ <br /> El Size: Diameter--------------------------------------Depth-------------- -------------- ------------- -........................gals <br /> Uquid Capacity.. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> f-I Distance to nearest lot line------------------------------------------------------................................................................................. <br /> Remodeling and/or ro,pairing (describe):--------/-d------ -------- ........ <br /> ................................................................................................................................................... <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I 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 regula-rions of the San Joaquin Local Health District. <br /> oa, --f'%� ....... ---------------------------------- ---------------------(owner and/or Cont rector) <br /> (Signed)----------- 42e–fe—r------ ---------ct$... ------------- ----------- <br /> 7in-r--iafiion-fo <br /> By:.....................I-. -------------- .....................--------------------(rifle)------------------- ---- ----------------------- ------------- <br /> em in�relafion to wells, buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, locii,�oni­66f sys <br /> FOR DEPARTMENT USE ONLY <br /> APPLI ATION ACCEPTED BY/,� -��--------------------- ..................................... DATE--- ------------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------............................................... <br /> BUILDINGPERMIT ISSUED..............................................................--------------------------------------- DATE............................................................. <br /> Alterationsand/or recommendations:............................................................................................................................................................. <br /> ........................................I..... ........................ -------------I---------------------------------------------------- ............................................................................ <br /> ............................................................................................................................................................................................................................ <br /> ...........................------ ................................................................................................................................................................... ...................... <br /> ..............................------------- .................................................................................................................................. ............................... ........ <br /> Date----J? <br /> FINAL INSPECTION -,-�--------------------------- ---------------------------- ---—----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 0-59 3M 3`63 F.P.120. <br />