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* , APPLICATION FOR SANITATION PERMIT Permit` No. •41---_---.--_. <br /> (Complete in Duplicate) II <br /> Date:issued Vc-Z/5--�-'- -, <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 madejnn-compliance with County Ordinance No. 549. <br /> r �+__.© ---��'A.,V. . cl,� ----�=-��Q T`� P <br /> JOB ADDRESS AND LOCATION_ __ �``'_ .//___________ � -- - - - -� P _ <br /> Owner's Name---------------------------------- a� /.rl+E'Rh7.t3i1�----- ----- -------------- Phonel { �� <br /> ' n ': n.._ __ h t _ f.� ------•-•---•-----------------•------- -- <br /> Address-•a?!- --•---"-------- P O._. d p <br /> /� / -------------------------------:------------------------------------ Phone1 <br /> Contractor's Name_____________________.---.--- `!---�= -------- <br /> --. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court Motel Other ❑ <br /> . � YLot s¢e� _ Y_R-_t�4111 <br /> ---_- a-�-X--�Q--�-- <br /> Number of living units: __. __ Number of bedrooms _--_ Number of baths -___.. <br /> Water Supply: Public system ❑ Community system (( Private ❑ Depth to Water Table _00ft.-04- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam I9 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Df New Construction: Yes ❑ No 00w� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i <br /> Septic Ta : Distance from nearest well-----------------Distance from foundation-------------------Material-----------',_'--.__..-_--------..-__------------- <br /> ®.j ll N& No. of compartments----- - ------------------Size--•--------------------•--------Liquid depthC-apacitY------------------ <br /> - <br /> Disposal_..�f ield: Distance from nearest well-----------------Distance from foundation___._________.__....Distance to nearest lot line----- ._____-( --A <br /> .®1StLIP4�r- Number of lines-----------------------------------Length of each line------------------------------Width of trench---------------------------------- <br /> F of filter material-------------------------Depth of filter material---..---__.__.._______Tota4 length----��'..------------------------.---- <br /> IN <br /> Seepage Pit: Distance to nearest well-ZQQ-____--Distanc`e,,fr�o_m, f undation-1L1_'--------Distance to nearest to line._.__ <br /> Number of pits.____J♦_______________Lining material_ -----Size: Diameter. ' .11.`_......De ��� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material-------------------------------._---- <br /> ❑ q Capacity ------gals; <br /> Size: Diameter--------------------------- Depth Liquid Ca acit� <br /> Privy: Distance from nearest well.- '_"----"-------------T------'-'Distance from nearest building--_-I- ------ <br /> ❑ Distance to nearest lot line------------------------ - ------------------ •--------------------- -------------------------------•------ ------------------------ - <br /> Remodeling and/or repairing {clescribe)------ 1- <br /> ----------------------------------------------------------•----------------------------------------------. --•-------••---------------------- <br /> -----••----------------•--•----------------------------- <br /> ----------------------------------- <br /> ---------•----------------------------------------------------------------------------------------------------- <br /> I <br /> ----- ----------------------------- •----•-----------­----------------­-----------•--- --•------ <br /> 1 hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Starews, and rule d regulations of the San Joaquin Local Health District. 1(Signed)-----__---_ L( -- { ` Contractor) <br /> itle +' <br /> dl,j <br /> By: --•--- <br /> (Plot plan, showing size of lot, location of system in rela n to wells, buildings, tc., can be placed on rover se side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y-_ j <br /> ; DATE -. '�� <br /> - ------------------- <br /> REVIEWEDBY------------------------------- --- ---- - ----- ---------- ---------•---------------------------------------- DATE--- ---------�M -------- <br /> BUILDINGPERMIT ISSUED---------------------------------- --------- ----------------------- ------------------------------- DATE------- -----------1------------------------------------- <br /> Alterations and/or recommendations:--------------- - - --- ----------------------------------------•----•------------------- SIN'-----•----------------••------------- <br /> --------•- -------- <br /> q•------•------------------------------ <br /> --------------•-------i---------------------•-------------•-- <br /> ------ -I1--------------------- -------•-------• <br /> --•----------------- -------------------I•-••---------=--- -•----------------------------------------------------------------------------------- <br /> % .e -- Date---- -- - - -- - -- ._ �. <br /> FINAL INSPECTION BY:-----------�'-' - •----------�---- -------•----- - --- - � -_I . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 8141 North "C" Street <br /> Stockton, California Lodi, California Manteca, California tUaey, California <br /> E5-9-2M 10.52'Revised W-2100 <br />