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a� APPLICATION FOR SANITATION PERMIT Permit No_ ___________ <br /> (Complete iri Duplicate) Date Issued / 3---2;;:3 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thwork herein described. <br /> This application is-made in compliance with County Ordina ce No. 542. <br /> �- --ry = - ---------------- - ------ <br /> !JOB ADDRESS AND LOCATION---- <br /> OCATI N---- ------ ------------- -- <br /> Owner's Name------- .. N_- Ph,,, 7------ <br /> 1A <br /> _---- <br /> 1Ad �dess_. � � ------ ------ --------------- �-- --- ------ - --- A <br /> I <br /> ---- <br /> kCo ----- - <br /> . <br /> ,tractor s Name .--y---- ----- <br /> JJ <br /> .. / ------- Phone.-V-7 <br /> Installation-Will ser eltResidence partment House ❑—Gmmercial <br /> ❑ Trailer Court ❑ Motel ❑ lOther ❑ <br /> Number of living unit: _c;;L Number of bedrooms _-Number of baths _r�,___ Lot size, __Ii.l_ _�!!- -+---------------_______ <br /> Water Supply: Put-171c s'�er [T�CoMmu.nity system [ Private ❑ Depth to Water Table. _ ft. <br /> � } I Y � I �, �1 i. x4;;m- ;racter of soil to a depth of 3 feet:' Sand ❑ Grasel ❑ Sandy Loam ❑ Clay LoHardpan ❑Previous Ap lication[Made- Yes,❑ do New Construction: Yes 0 NoTYPE OF M ST' ALATION D(SPECIFICATIONS: <br /> (Noleptic tank or cesspool)permitted�iff public sewer is. available.within 200'feet.) <br /> Septic Tank! Distance from nearest well___ Distance from foundation__-- -------Material___---------------------- <br /> ------------ ----------- V\ <br /> No. of compartments------------- ------------Size----------------- Liquid de th----'---- �_A Capacity <br /> 11 :1P 1Disposal Field: Distance from nearest well__ -Distance from foundation_____I -____-Distand�to nearest lot line__�--d____. <br /> CO- <br /> Number of lines!----------------- __ Length of each line_______ _ _.- __,�-- Vti]dthof trench-------- __ -------.--- <br /> . Type of filter material____ 4--- -_:Depth of filter material <br /> ____1_ Tofal len li_ ______ Gf_______________________� <br /> Seepage Pit: Distance to [earest!'w II_- _____Distance from�oundation___:_ �J_____.Dis nce�to:nearest low lin 4 <br /> Number of pits-�---t__�---------'fining mate*ial_2_q:- .-Size: Diameter-------�O-------.Depth----O��---------------- <br /> .}y <br /> 1 <br /> �.Ce�spo ._... Distance from nearest well_. ____ ..._._Distance from..foundation ---___ ______ Lining material -----------------__ _-_,____. <br /> . r---^w-Size-:'Diameter---I---;F;_�-, _----------- Depth----------------------------------------- -----Liquid Capacity----------------- ----g <br /> Priv Distance from nearest well-_____________ _ ___-_______. __-_-_.____ _Distance from nearest building?! -_ ------------------------------- <br /> 4 <br /> Y <br /> I'® Distance to nearest lot line--------------------------------------------- <br /> ----------------%----------- g <br /> Remdeling and/or repairing (describe)- ---- --------------------------------•-••----------------------------------------------- ------------ ------------ ---------------------------- <br /> - Ai--------- ' --------------------I---------------------------------------_------�------------------------------------------- <br /> J,21-YI-------------­_­---------------------- <br /> I-----;---------•-------------------------- ------ ....... --------------------•------------------------------------------------------ -------9------------------------------------------------------------------- <br /> % <br /> ----------------------------------------- --------------------Yn----------------------------------------------------------------------------------------------------------------------- ---- <br /> 1 hereby certify that I have pre�,ared'this application and that the work will be done in accordance,with San Joaquin County <br /> r rdin`ances;�-St a laws, and ru. s and retgulations.of'the San aaquin Local Health District. �3 3 <br /> Si ned ' t.✓ ', = == - �'------'- -------- -------- }ti.r and/or Contractor) <br /> [ g } i <br /> 1 BY:------ ; (Title)-- ` ---- -- -------------- <br /> [Plot plan, showing size of lot, location of syster in relation to wells, buildings, etc., can be placed on reverse side). <br /> a <br /> FOR DEPARTMENT USE ONLY <br /> 9 N ACCEPTED BY_-) l -- DATE_sem'__. -------------------- <br /> --------------------------------- ----------------------------------------------- - <br /> APPLICATI Y - DATE-- !i i� t <br /> REVIEWED 6 - - -- - - -------------------- ------------------------------------- - <br /> � . R <br /> UILDING PEIRMIT ISSUED # _ "DATE ------=----------------------- <br /> l # -------------- --------- k # <br /> ,�I+orations and/or recommendations:--------- ------------------ ---------.------------------------------------�---- - �•-•- ---- - --------------- <br /> # t 11 1f-------------- .. ---------------------------- ---------------------- ----- ------------ <br /> -------------- <br /> •---------- <br /> ----------- -- -- <br /> 1 y P F .� ~' -------------- 1 -- --- ------------ <br /> I , <br /> -_---- _ ------- <br /> - - - -- ----------- ---------------=-----------------------------------=--------- ---------- - -- --- --- ---------- <br /> --------------------------------- - - <br /> C> jT <br /> AL INSPECTION BY:. _-: ..... -x Date-------- <br /> ----- <br /> €. "x SAN JOAQUIN LOCAL HEALTH DISTRICT' <br /> w:7 0 South American,3treof 300 West Oak Street—i= i32 Sycamore Street 814 North "C" Street <br /> :-,Stockton, California Loci,-California r. Manteca, California Tracy, California <br /> �M 0-52 Reviised..W-2100 <br />