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FOROFFICE USE: / <br /> ----- ------------ ------------ - <br /> -- <br /> ________________________.___.._____._. • APPLICATION FOR SANITATION PERMIT Permit No. <br /> _a ----------------------- -------------------- ---------- (ComphAe in Duplicafe) <br /> ' bate Issued <br /> i � i- -------- -------- �-��---�---------------- -- � � This permit Expires 1 Year From Date Issued <br />' Application-is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> L This application is made in co pliance with County Ordinance No..549. 0 <br /> Ytf 7 4�YID .5 <br /> _. <br /> JOB ADDRESS AND LOCATION_.: ilU ---- ---.- <br /> -------------------—D�---------- --..t1` --------V <br /> Owner's Name----------------- , } <br /> } -------------RD—,----------- <br /> 1- I — Phone <br /> ------------- - •------------------ <br /> Address-------------- - T `�` C7 /0-5 3 -- �-?-C;'±�1 / . <br /> Contractor's Name_ 14.�__. _ ------------ Phone__--------------------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---I--- Number of bedrooms _--- Number of baths 1---Lot size _!�_L�_�1���____-.•_____________________ <br /> Water Supply: Public system ❑ i Community system E] Private Z---Depth to-Water Table 367ft` r' <br /> Character of soil to a depth of 3 feet: Sand C-] Gravel E] Sandy Loam Clay Loam E] Clay ❑ Adobe [3 Hardpan E] <br /> Previous Application Made: (If yes,;date............._---__) No New Construction: Yes E-INo ❑ 'FHA/VA: Yes ❑ No <br /> rte—..6 TYPE-�OF_INSTALLATION'-AND SP•ECIFICAT-IONS: _ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Distance from nearest well_____! P......Distance from foundation---14----------Maferial_j�C R—E­T--f�� <br /> No. of compartments_.__ -------------Size 1 d_X ___--:--,Liquid depth---.5-............------Capacity_1>7�_RP'----- <br /> Disposal Field: Distance from nearesf well--- d_-.._Distance'from foundation_=_:1Q_ tante to nearest lot line----------------- <br /> Number <br /> S_._._____Number of linest`_.�--_----------------- of each line"� _-3___ - ---Width of tren <br /> Length � <br /> - �r <br /> g - cFi�-------��-f----------- 1 <br /> Type of filter material__84 C. 'ri__.___Depth of filter material___--�` __t____.._Total length---------------------f-7 <br /> Seepage Pit, Dis#ante to nearestIV <br /> ell 7_ ._ Distance from foundation =__I ______ Distance� to nearest lot ., <br /> Number of pits__ ------ -------- Lining material- Size, Diameter._e_x_!-:? -----Depth-------[-�--_----------' <br /> r ZEJ�;�� -- <br /> Cesspool: i Distance from nearest-well.___:___._.__Distance from oundafion:a------------------Lining material____---____.__.--.-.-___._ - <br /> ❑ Size: Diameter------------------------ ----------Depth----------- ----------------------------------------Liquid Capacity----------------------------gals. .� <br /> Privy: Distance from nearest well------------------------- ------------------Distance from nearest b0clin <br /> ❑% F Distance to nearest lot line---------- ------- ----------------------------------------------- <br /> Remodel,.. <br /> --------------ling'and/or repairing (describe):------ - ---- ......----•- •-----...----------•---------------•------•-- <br /> ---------------------------- ----------------------------------------------------------------------------------------------- <br /> --------- ---------- -. <br /> ------------ ----------------------------------------- - <br /> --- ------------------------------------- <br /> ----- ------------------------------ ----------------•--•--- - <br /> I h'ere6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County C <br /> ordinances, State laws, and rules and regulatWcofthhen Joaquin-Local Health District. <br /> �(Signed} r ne-------_-- -- - � antra <br /> 4 fof <br /> gY • -------------------------------------- ---------------------------- --------------------------------------------(Title)- - ----- <br /> w rand Contractor) <br /> - _ x - <br /> -----------------• ----------- <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 ` -__.�r------------ - DATE --f. _..'-_ <br /> REVIEWED BY _ <br /> ------ -------------------------------- DATE ' <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------._ DATE- <br /> - ------------------------- <br /> Alterations and/or�recommendations:.------ ----------------------- -- ---------- <br /> --- ------------------------------------------------------ <br /> ---------- ------------------------------------------- ------) <br /> ------ --- ---•-------- ------------------- ------------ <br /> - I , <br /> FINAL INSPECTION .. - Date------------ � .� = <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Harollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />