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_ FOR OFFICE USE: <br /> a <br /> /,? - APPLICATION FOR.;SANITATION PERMIT Permit No. _. . <br /> -- ! <br /> ----------------- -- ' ----------------------- {Complete;lit Duplicate) 71 LJ <br /> --____._-__.__ This Permit Expires 1 Year From Date Issued 'b'ed <br /> Date issued <br /> --------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct�an�s?all the work herein descr€ _ . <br /> 3 . :.z w +. <br /> This application is made in coiinpllance with County Ordinance No.-549. <br /> s : DLOCATION _JOB ADDRESS AN .... � l'I <br /> sy � <br /> Phone------Owner's Name----- -- - -------- -- --------------__,_ ---------- <br /> ------ <br /> -...-•-- - <br /> __._______ __ ___ ______ ------------------------------------_ - ---- <br /> Address -- ----- - ----- <br /> 4 - _a� i <br /> t <br /> Contractors Name---- ll-L� �ld-.r..- - -- _ f - <br /> Installation will serve: Reside ce,JZ Apartment,House ❑ Comm`'e rciai' ❑ Trailer Court,❑ Morel ❑ Other ® W <br /> Number of living units: ._- -_ Number of bedros __/___ Number of baths om - --- Lot size ---••=• <br /> Water Supply: Public system 9 Commtity system_❑ -Private ❑ Depth to Water Table <br /> Chiaracter of soil to a depth of 3 fee-t---1Sa- d[]�Gea� el [I Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br />' Previous Application Made: (If yes,`date__ _`__- -`:h- _f__f No4 New Construction: Yes [M No [IFHA/VA: Yeses NOR <br /> TYPE OF INSTALLATION':4ND SACIFICATICNS:�-�� <br /> I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__ Distance fro fo ndation---/U <br /> r --------...Materiel.. -- -- - - - - -'----------- <br /> I A spry No. of compartments--------- ---'----Size_J�,Y), Y- l-------Liquid depth------ -'-'---------Capacity._..., - Q---- <br /> jDisposala <br /> Field: . Distance from nearest weH. Distance from four dation---/&/ Distance to nearest lot Iii e------U��/__ , <br /> Number of lines_____________ ength of each line--_------ --p Width of trench_____ �_ <br /> ------------------- <br /> } ' 'Type of filter materia_ _ of filter mater€al---I ----� --_._Total length____-__ ______________ <br /> /10 <br /> -----------Djstan;e tq nearest lot <br />€. Seepsge'Pit` Distance to nearest welLt----Distance f m undation__ <br />� Number of�pits—f --_-------�Linng material-- _ ----- --�-_5ize: Dia,me#er_�f � _ <br /> � Depth-----�lie_ <br /> ----------- <br /> --- <br /> kC ss�pool: �<jDistance from nearest waif-_' _______-.-_-Distance from foundation____________________Lining materia. __-.________.._____ <br /> r i ❑ <br /> Size: Diameter � Depth = Liquibui dapacitY ------ ------gals. <br /> -'y f ---------------------t-Distance from nearest g # . <br /> Privy: Dis#ante from nearest.well----------F_-- -_-_-- 1 �_w_----------__`_1--.--�,--- <br /> I C! Distance to nearest�,lot'Iine_- r____.l_ <br /> ❑ � Ja f <br /> Remodeiin { t � l �' ---- - --- ------- <br /> ger• d/or epairin (descrilse): , ----- - ----------- ' <br /> ------ + _ <br /> * 5 , <br /> i I herelirtif that I ve re'aced,this a ication and that the work will be done to accordance with San Joaquin County <br /> ordinance', St to laws, an tiles and regulatio of the;San Joaquin Local Health District;;\ <br /> T;. ;; "(Ownt �arid/or Contractor'; <br /> h <br /> (Signed)-- ------------------•�------------------- ---- ----------=-----' . <br /> . ----------�__(vie)--------:----> �' . ,. <br /> --------- <br /> 01-----------------­-4r ------------------ <br /> (Plot plan, showing size of to#, location of system to relation to wells, buildings, etc., caK,be placed-(In reverse side.ti.-. <br /> FOR DEPARTMENT USE O L <br /> I S _ <br /> 1 'pATE'``''' 77, <br /> 1 <br /> APPLICATION ACCEPTED BY - f <br /> REVIEWEDBY------••---------------------------- - ' ` ---------------------- ----- ' ---. DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED----------------:-------------------------------------------------------- -:._ DATE-------: _ ------------ -- <br /> �-- <br /> e --- - ------------------- <br /> Ac.:lt..e.rat-io- <br /> ns a d/or Srrecommendat¢io�ns _ <br /> a src <br /> Q rte - x --r-7' 7� �1r � € <br /> �� �L, - • <br /> - _ --------------- -------' -- ------ ------------------------ -------- <br /> �p . <br /> _ a' <br /> �._�r'•. —.—,�-•...- ° �. ref <br /> 1�cFINAL INSPECTION"BY:.. --�r--cr-� Date__----. Z <br /> ___ ------i� � ) .) �. .1 :s 'C; ti �, 13 \�� Com'_'• �'+�, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT-= \ <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 JeEV19E0 0.59 F,F.CO.2M 5.60 <br /> K <br /> n <br />