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-- -------------- ------ - -------- ------------------- q <br /> /. - ; ---_-- APPLICATION 0011 SANITATION PERMIT Permit No. _..Expires i Year From Date Issued A <br /> ! <br /> - (Complete in Duplicate) <br /> This Permit Ei <br /> Date Issued -_--i/ , Z <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 made in compliance wiit�h County Ordina No. 549. - <br /> JOB ADDRESS AND LOC N...-__.N-- ._ Q <br /> --------------­- ------------•- -- -- <br /> Owner's Name.......... <br /> -( r------------- ��----••--------------------- ------------------------------------ <br /> -------- Pho l.Q- _ <br /> /Address-----•----•-------..... �Y.� f1-rc.. �7 �'/7• <br /> Contractor's Name.. - _0 1 /� ¢ fy r` <br /> ... _. ..t-�. f`• './. t �-g^------ Phone. (7... <br /> Installation will serve: Residence Apartment House ❑ I�ercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units- -------- N mber of bedrooms .-- Number of baths ..--3-..-- Lot size <br /> --• --•------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4bft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ETIHerdpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q <br /> Septi T Distance from nearest well___AM.Cz-Distance fro foo „ion---I.0---------. ate ial_.. -� �_ <br /> �T6 <br /> No. of compartments--- ------ Size �..-�---- --------Liquid depth-_.�_ f�--------capacity------ 4'� <br /> Disposal eld: Distance from nears well-�_P .- <br /> pY � S� - - ista� from fo rdation------l4_`-_..Distance to nearest lot line._,. 4f ;"� ' <br /> [� Number of lines.___-QS---- ----- --- - Length of each line-_ _ ?-� ^0 ----------- <br /> Width of trench-54.$.4' --_- ' <br /> ii •------...- <br /> Type of filter material... -- �._-Depth of filter material..__- t----- <br /> ----- length---------------- ......`-•.•_______ <br /> Seepage Pit: Distance to nearest well----NP-)ff-----Distance from foundation-_/-0- to nearest lot line......��� <br /> Number of pits---s--------------Lining material-IRP. ---..-- Size: Diameter----0_r3 ___Depth___.2- ---------,------- <br /> Cesspool: Distance from nearest well-----------------Distance fro. -foundation._.------_-.-----_.Lining material----------I——-_---_ <br /> ❑ Size: Diameter ----------•--Depth------------------- --------------------------------Liquid Capacity--_-----------------------gals. <br /> Privy: Distance from nearest well----------------------------------------- .------Distance from nearest building <br /> ❑ Distance to nearest lot line--------- ---------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)--------------- <br /> ----------•-•----•.---•------------ ------------------••-•---•--------- I <br /> -•------------------••--•--•-•-------...------------------------------•------•-....------ <br /> i <br /> I heyb � y that I have prepared his application and that work will be done in accordance with San Joaquin County <br /> ordinancw d rules and r u tions oft an Jo in L ai Health District. <br /> -..: ll <br /> (Signed)- <br /> ... ... f� l'1 -. �,� ------.[9wee1�flvr Contractor) <br /> By----------------•--•--------- .---------------..----------------------------------- . ---- ---•- --------------e)------- - <br /> -. (Title) <br /> (Plot plan, showing size of to+, location of system in relation +o ells, buildings, c., can be placed on reverse side). <br /> R DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> -------------B--y----------•--•-------------�--------------------------------------------------------• ---------------------------•---•--•------.•------- DATE61'tEVIEWED BY ------- ---1'Gf <br /> -- <br /> UILDlNG PERMIT ISSUEDDATE------•---------------••-•-------------------------------- <br /> - - ---------------------------------------------------- <br /> -----•------------------•-••---. .:-------•-••-----------••-------------------•-------- DATE.------------------- <br /> Alterations and/or recommendations:---�o--.Z-1_-�_� I--yx. <br /> ------ ----------------- ------------ <br /> --- -------- <br /> ------------------------------------ <br /> -------- <br /> .. <br /> -- - -�-.----•-• --- ---- ... <br /> _ -------- <br /> ,r -.------ <br /> FINAL INSPECTION B <br /> -....oma Date-------------- Y '-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American greet 300 West Oak Street 134 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Mantua,California Tracy,California <br /> E8 9 REVISED B-89 PM y-67 ATLAS <br />