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rtJKUrriL.t U-= <br />� � /•� APPLICATION FOR <br /> --- -- -------- ------------------------- R SANITATION PERMIT Permit No. ...,( /- <br /> ----------------- (Complete in Duplicate) Date y��i <br /> .--.--- This Permit Expires 1 Year From Date Issued Date Issued ._....1.............. <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 LOCfAT N- ?. ..... f,� �_. r, __ .../.1 ,� U �� 1/r'; _ �"1 <br /> Owner's Name--_._ a ../dk2/.1V 1......."_T�Z�-A4e.�--------------------•------------------------------- Phone.................................... <br /> Address �`c7L�( -.. _ ,�.f �9/ /•-��r'f1�cl �. �.�r, .lG .- ------------------------------------------- <br /> Contractor's Name-------_ ?,--- <br /> ................-........... Phone. � 7rt� , <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -------- Number of bedrooms -------- Number of baths __/--- Lot size .. 5�-� <br /> Water Supply: Public system ❑ Community system ❑ Private f Depth to Water Table __7__ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy\Loam ❑ Clay Loam Clay E] Adobe E] Hardpan [3Previous Application Made: (If yes,date--------------------) No� New Construction: Yes No ❑ FHA/VA: Yes ❑ No [3TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r ,� L <br /> Septic Tank: Distance from nearest well--4- Distance from foundation_--- Material------ _ -- -: Q <br /> No. of compartments----.T—---------------Size.._A_X.Si i..`..._._Liquid depth--.--�-�-----------Capacity.... ..e. <br /> Dispo\\\sal Field: Distance from nearest well---_,-_0_r--.-Distance from foundation..... Distance to nearest lot linefr .....1.... <br /> Number of lines---------j---- Length of each line..... -_--j-. Width of trench----X.-.5 ................... +� <br /> T e of filter material...-. ..-_ _CIC--De <br /> --Depth of filter material---- -_¢ -------_--Total length _...-__ 1 <br /> YP P a� 9 N <br /> Seepage Pit: Distance to nearest well-_-------------------Distance ftom foundation-------------.------Distance to nearest lot line---___----------- <br /> ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-------------------------Depth--.-----..._..-.._.-..----------. <br /> Cesspool: Distance from nearest well------ ---------Distance from foundation--------------------Lining material..................................... <br /> Size: Diameter---------------------- ------ <br /> ..-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 /> ---------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------=----------------------------------------------------•..................----------------------------------------------------------------------------------------------------- -- -- - -- t <br /> I hereby certify that I have pre - application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law and rules regul ' ns of the San Joaq ' Local Health District. <br /> (2f(J// <br /> (Signed)----------- �. / - - - �-----•----- - (Owner and/or Contractor) <br /> By:............... �------------------------------------ �re <br /> � ....---•-•......-.._{rtlel --•------ <br /> (Plot plan, showing size.of lot, location of syst mon to wells, buil s, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- fukA--- -- --------------------------------------------- ----------------• - <br /> DATE. --------- <br /> -------------------- <br /> REVIEWEDBY------------------------------f••------------------------------------------------- --------_-- -.-_ DATE S <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations--------------- <br /> -------------------------------•-•------.-...---------.-...-----------------------•-----....--------------------------------------------------------•-•---......_...-•------------------------------.----------------.-..-..._ <br /> FINAL INSPECTION BY:----,----- - -- -­----------------------- Date�------�31 ------ - - --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfreet 300 West Oak Street 124 Sycamore street 305 west 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B•59 2M 5.61 ATLAS <br />