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FOR OFFICE USE: <br /> ---------------- ---------------- r--------- ---- <br /> ,- APPLICATION FOR SANITATION PERMIT Permit No. f�3. <br /> - _ `= <br /> _ (Complete m Duplicate) Date Issued -- <br /> -------------------.� <br /> _-_ --- ., This Permit Expires 1 Year From Date Issued <br /> 2`�-5—270 --Oto <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 with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_S�L>T� ___�FpF�~__:fyc�•-1�v� "_�-c._______� -_ �/ -=----- <br /> IOwner's Name ---------------�4� 9S-�C� --------------------------------- -- ------------- Phone__ji- K7 <br /> Address =- - [ e7x f �1:/ .Q 1_ -. �'----------- <br />° rn <br /> Contractor's Name---- --•----/-- ..H 5 ;z Phone �2-1f' � <br /> Installation will serve: Residence ..Apartment House ❑ Commercial '❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----- Number of bedrooms 3--- Number of baths -�f----- Lot size __��_±�---a �------------------- <br /> Water Supply: Public system ❑ Community system ❑` Private V Depth to Water Table'ZOTt""., <br /> ' Character of soil to.a depth of 3 feet: SandX Gravel ❑ Sandy Loam ❑ Clay-Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------J No New Construction Yes Sd No ❑ FHA/VA: Yes ❑ No <br /> Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: p <br /> (No septic tank or cesspool permitted if public sewer is available within-200 feet.) <br /> Septic Tank: Distance from nearest well +C►S�" __•Di'stancet from fol�ndation__f ____-_- Mater�al_'_ _ - <br /> t No. of compartments___ _�. Size , _ _K ___ __-__Liquid depth _.S 4___-___---__Capacity_/Z-o-0 r-4 <br /> r r <br /> Disposal Field: >. Distance from nearest well_._.✓_..._Distance from foundation---�_��_--------Distance to nearest lot line__- ---------- <br /> J Number of lines- __7'W_�----------------Length of each line, ._ _ " 3_.Width of trench___��'1____________-___ <br /> i tr <br /> Type of filter-matenal_I�«je�CKDepth of filter material___�-_�__.-.-_._->Total length_-._____ _S _____________________ <br /> Seepage Pit: i Distance to nearest well---------------------- from foundation------------------ Distance to nearest lot line----------------- <br /> El <br /> _--_-____ -.❑ [ Number of pits- =-='-------Lining material-----------------------Size: Diameter---'-----------_.--._Depth-------------------------------- <br /> - <br /> Distance from neaares IL, __--__-_-Distance from found ion _____. Lining material-_._.-.________ __________________ <br /> ❑ Size: Mameter ^ _� �..r�_..- Depth_.= Llquld Capacity----------------- _T :_gals� F <br /> .I Wvy' vhf <br /> I `Privy: a. Distance from .nearest well-----------. ______ ___ _____ ___ Distance from nearest building____ ___-__--_ ___:p..__ _._. <br /> ❑ °` a Distance.to nearest lot lire---------------- "' " - _ <br /> l <br /> � til <br /> 3 <br /> Remodeling and/or repairing (describe}:__-. . ---_-__„-_ _ - -------------- -- ------------- <br /> 4 <br /> -- <br /> -------- ---- ` ---------- <br /> = ---------- ---- ----- <br /> --- ------ <br /> I hereby certify that I ave repared this application`arid'tjiat the work will be done in accordance with San Joagain County <br /> ordinances, State laws, an rules and regulation f the San Joaquin Loc ealih District. <br /> - ----- = <br /> Contractor] <br /> ($igned)----------------------------- -- -- - --------------- -------•--- rid/or • <br /> Title <br /> -------------------------------------- <br /> .(Plot plan_,._showing.size of jot, location_of.sysfem in relation to wells,_buildings,etc., can be pla on,re_v_erse side).-_w;,,. . <br /> FOR DEPARTMENT USE ONLY <br /> v . <br /> APPLICATION ACCEPTED BY ! .-�� - DATE-------- ---------------- <br /> r- REVIEWED BY---------=----------------------------------- - ------------------------- ---------------------------------------------------- DATE---------------------------------------------------------- - <br /> BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------- ---------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:------ -------------------------------- -------- ---------------------------------------------------------------------•------------------------- <br /> --------:%---------------- ------------------­­ ----------------------------- <br /> -- <br /> -------------- --------------------------- --------------------------- - - <br /> ---------------------- - / ! - -_------ ---- --- -------------- - --- ------------------------------ ------------- --------------------- --------------------- <br /> FINAL INSPECTI ----- Date-------------- -- - .Z <br /> ti <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> _ I, <br />