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FOR OFFACE USE: <br /> ________________- _ _ __ ___ ____ ___-____--- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------ (Complete in Duplicate) /S <br /> -------------------------- ---- / <br /> _-_._____------------- ---------'_-------_-_-_.-_ This Permit Expires 1 Year From Date Issued <br /> Date 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 compliant with CperyF556nance No. 549. � MTC6 <br /> JOB ADDRESS AND LOCATI 5----. ._ -0-5TTi--A-1......13D:_-_/-_�-- .s...--.l.v__---OF----l7_��Y---ZZo---------------- <br /> Owner's Name-------------- 13N �.y-� Phone. <br /> Q - ---- --•-----------•------------------------------------------------------------ <br /> Address---------------L ( ----------6QT.TAT.E--------AI -�-----------IrC -----------­7 ............................................................... <br /> Contractor's Name--;._-1.------LLE---- ------------ Phone----------------------------------- <br /> Installation will serve: Residence,Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ <br /> Number of living units: ------- Nurr><ber of bedrooms -.- Number of baths _2 Lot size ------/_.S_0QQ--_a-.._-_fi------------ <br /> Water Supply: Public system ❑ Communityy __s tem ❑ Private E] Depth to Water Table -------- ft. <br /> t"b c1 RS _ <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ �1 <br /> Previous Application Made: (If yes,date------------.-------) No E5- New Construction: Yes �lo E] FHA/VA: Yes ❑ No ffr"((nn-i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: W <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-_ P-----Distance from foundation----1 ----------Mate r'al-------COAIC RET------------ <br /> K, No. of compartments--Z---------------- ...Liquid depth---- ----------Capacity.../zO V---- <br /> Disposal Field: Distance from nearest well-_5 ------Distance from foundation----�d.--. Distance to nearest lot line--5---------- <br /> P <br /> ®� Number oaf Jnes_...---7- _.--_-__--_--Length of each line-------9Q"f'_�-6.-.Width of trench.___--_ _--- -___--_.-_ <br /> Type of filter material---RO<.K----Depth of filter material------j9_-...'--_-..Total length------------- ©A--------�`----- <br /> Seepage Pit: Distance to nearest 9.1ell------ ---------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> E] Number of pits-_-----------------------Lining material-----------.-----------Size: Diameter.-----------------.----Depth---------------_-_-------__.--- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---._--------------Lining material----._---_--.----.-----------_.---.-. <br /> ❑ Size: Diamet " - ----- -----------------Depth------------------------------------------ A.Liclu d Capacity ------------------------gals. <br /> Privy: Distance froearest well_--------------__-_-__-_-___-_._-_-_---____Distance from neaest buildin <br /> 9------------------------------------------ <br /> Distance <br /> - <br /> Distanceto nearest lot line-------------------------- ------------------------------------------------------•------------------------------ ------------------------- <br /> Remodeling and/or repairing (describe):--------�` ----••-------------------•-------•---•------- --------------------•--------------------•---.......... t <br /> --------------------------------------------------rlesarn�d <br /> --------------------------------------------------- ---•----------------------------------- - --- --- --- <br /> I hereby certify t hared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta e S. tl tegulations of the San Joaquin Local Health District. <br /> (Sign <br /> ---- <br /> L (Owner and/or Contractor) <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). <br /> FOR DEPARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED BY----- � --------------------- ---------------------------------------------- DATE--------- 1—___---6�----------------------- <br /> REVIEWEDBY--------------------------------------------- --------------------------------------------------------------- ------ DATE------ -----------------.----------------------------------- <br /> BUILDINGPERMIT ISSUED----------V4--_46----------------------------------------------------------------------------- DATE----------------------- ------------------------------------- <br /> Alterations and/or recommendations:----REplat_ -------OoL. ____lN....PA-PA_rt �_-___/N.-_--TAtJK-a ------------------------------------- <br /> ----------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----- -------------------- ------------------------------ ----------------------------------- --------------------------------------------------- <br /> f''7 <br /> -- - - ---------- ------------------------------------------------------------------------------------------- <br /> -- ------- --------------- --------------------------------- ------------------------------------ { <br /> FINAL INSPECTIOI �Y/. ~ 7- <br /> - - -- ------- ---- ------ - Date - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />