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FOR OFFICE USE: k <br /> ----------- <br /> APPLICATION FOR- SANITATION PERMIT Permit No. ..Q :10 <br /> (Complete in Duplicate) <br /> ----------------- This Permit Expires 1 Year From Date Issued ©ate Issued <br /> Application is hereby made to the San Joaquin Local Healfh District"for a permit to construct and install the work herein described. <br /> This applicatiori,is made in compliance with County O ce No. 549, <br /> l <br /> JOB ADDRESS AND OC ON--- -��--- ---- ------ ------------ ------ ------------ -- --------------------- --------------------- <br /> Owner's Name---- -- - -t- -•-- --I` -•----------- ---------------- <br /> _, -- -- <br /> Address----------------------: �__ --------------------------------------------------••---- --•- <br /> Contra' dors' Nam _ = --- ----------------------- hon <br /> Insfallation will serve: 'Residence "'Apartment rtment H se ❑ Commlercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ _ Number of bedrooms ,.!___ Number' >� � ber of baths _ , ��• <br /> -�- Lot size --:S _�.7�- ��®---�---�--------- <br /> il< <br /> Water Supply: Public system- Community system ❑ Private ❑ Depth to Water Table .------- ft. <br /> r. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.E] Clay Loam ❑ Clay ❑ AdobeHardpan ❑ <br /> ',.Previous Application Made: (If yes,dgte____________________5 No ❑ New Construction: Yes ❑ Na FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> : (No septic tank or cesspool permitted if ublic sewer is available within 200 feet <br /> v � _-__- - -- cue from fou Vin__----•----------.Materia --___--- - 1 <br /> Se tic ank: "•'"Distance from nearest w II_ __ Distan <br /> No. of compartments_ _ Sizw :_,[_ -__.___Liquid depth `/-____._____Capacity__ Q � <br /> Dispos I•Field: Distance.from nearest welljimv._Distance from found n__F-_ _-_.Distance to nearest lot line-------- . <br /> Number of line's"`___-___ 1_ Len th of each line- �__�----'"'___.-.Width of trench _ � <br /> Sv <br /> -- <br /> -, <br /> Type of filter maferias p ter material__ _ _ __ Total length__________________ ---------- <br /> 3 <br /> "r <br /> See a Pit: Distance to near st we11_ _ • ____Distance from Depth of filter <br /> p __ -.- # om oundation____ __!�_� Distance to nearest lot line_________ <br /> j - J3 <br /> p• 1 - g Size: Diameter---. .. Depth__--_- "v . <br /> - -- - -- ----- - - <br /> Cess o Distance f om nearest well_________________Distance fr <br /> Number o its___ __ _____ ___ _ ___Linin materia__ @ { <br /> p o ------ ion-------------------Lining material--- ------------------------------•- ! <br /> t -- --�.,1------ - -------- -------------gals. <br /> Size: Diameter-___---- ---- � <br /> ❑ -- - - =Depth ----- .- ------ ---- --- - - ----- Liquid Capac,tY- <br /> Privy: Distance from nearest well----------------------- -_-.--___- -----------Distance from nearest building--- ---- --_ --- <br /> ❑ i Distance to nearest lot line------------------------- -- --- -�-#j-------- ----- I <br /> Remodeling grid/:or repairing A(descrihe)= , - ----- j - -------------------------- ----------- <br /> m ' :fi <br /> —1 "' ' _ - -------------------------------- -------- -- <br /> UX <br /> -------------------------------------------------------------•-----------------•--------------- ------•--- ------------=•------•---------------- ---------------------------------------------------------------- <br /> -- --------------------------------------------------------------------------------------------------------- ------------------------------------------ -------------------------------------------------------------- <br /> I hereby certify that I have prepared this application.and that,fhe work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed' a `'Ji la= ------------------------------ ------------------------------- ------------------ --(C -amdAr, Contractor <br /> SEPTIC 7•ANK SERVICE k} <br /> Plot Ian, showing size of lot, location of system ,n rely - to wells,'------ --- --- - --- ------(Title)_-_--_-_-_''-_--__-_-.-._______.-_..-_-.-_--.. _ ----------_._- <br /> B <br /> ( P wingiFler-e of -, location <br /> tion syst --- - -- uildi s, etc., can be placed on reverse side). <br /> O DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------9_ __-f7 <br /> ---- DATE-------� -� � <br /> REVIEWEDBY---------- -------- --- - --- -----------��---------------------------------- DATE-------' '-------------------------_•-------•---------- <br /> PERMIT ISSUED--------------- ---- -----------= ------------------- <br /> BUILDING ---------- DATE--------==------------------------------------------------- <br /> Alterations and/or recommendations:. �' -----------------------------------------------•-------•--------••---------------------------- <br /> ­ <br /> ------------------- <br /> --------------------------- --- - -----------•----------- ---- - I-- ---------------------------------- <br /> --------------------------------------------------------- -----------------------•---------------------------------1-------------------- -------------- ----------- - ----------------- - -------------------------------- <br /> I <br /> k, I <br /> FINAL INSPECTION BY:.-- Date <br /> 9� <br /> j° SAN O UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California i Manteca,California Tracy,California <br /> F.P.CC. !kl iL <br /> It �l.l <br />