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APPLICATION FUR SANITATION PERMIT Permit No. _. ._ <br /> I {Complete in Duplicate} <br /> - - Date Issued ---------- � Z <br />-_--(�__._.__..__f-~: X17-., /_ /,`��: - }-• ¢This Permit Ex ares 1 Year From ate Issued <br /> Application is hereby made tc the San Joaquin Local Healfh'D' riot for a permit to construct and install;therkherein described. <br /> This application is made in compliance withCounty O/rdinanc No. 54J JOB ADDRESS AND LOCA ON_ __ : � _ ._! .. ... - -G�pC�"/-- —------------- -- <br /> --- -- .Owner's Name-------------- -- -----4-•-- r. - ----- :/ ----- ----- -------------- �-�_ �E?U. <br /> Address ..... --- - .i Q-.�.. ------------------------------------------------------------ ................................... <br /> Contractors Name...................1........ /.. ----------------------------------------------------••------•-•-------•--- Phone----------------------------------- <br /> Installation <br /> F - <br /> Installation will serve: Residence Apartmen+ House ❑ .`Commercial ❑ Trailer Court ❑ Motel�] Other E] <br /> Number of living units: _'__.:Number of bedrooms .__1--- Number of baths _ Lot size ____ Q- _ _(� }1/1 / t <br /> - -- 3#K 3..............•-------_ <br /> Water Supply: Public system '❑ Conimuriity-syst ❑ Private ❑ Depth to Water Tab ft. 1 <br /> Character of soil to a depth of 3 feet: Sand ravel 0- Sandy Loam ❑ Clay Loam�/Nlo <br /> ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date.q, �_ J No New Construction: Yes ❑ FHA/VA: Yes ❑ No [> <br /> TYPE OF INSTALLATION AND SPECIFI ATI01Q5d, <br /> No septic tank or cesspool permitted if publicewer is available within-200 feet. <br /> 5eptic/Tank: Distance from nearest well _....__Distance from fo�ndat�n----L__Q_ ._:.Ma 01-------- ------------ <br /> No. of compartments vZ Size°_ !�. i q p.}� ---- ---- p Y ----- ----/ <br /> 5,. X.�_Li uid de / Capa &V <br /> Dispos Field: Distance from nearest w --_----Distance"from foundation_ __________.Distance to nearest lomat line...... <br /> I �} <br /> dumber of.lines_________ ...yr__ _-----_Length of each line-------_ __; _ _.� Width of trench.-_--__ <br /> r <br /> I Type of filter material__ _ epth-of filter material-----��---_---Total length----------t��----------------------- <br /> I: <br /> Seepage Pit: Distance to nearest well----------------------Distance from 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------.-...__.---._-._-...----------- v <br /> ❑ Size: Diameter---------------------------------------Depth``.----------------------------------------- --#- Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------___--_____-------_-_--_--- Distance from nearest building--_--------___----------_---_-_.-._._-.. \ <br /> Distance to newest lot line-----.__.-------- <br /> -------:F._--_.-------------------------------------- <br /> Remodeling and/or repairing (describe) ""b{ s ,P' _ _ �lf .-h ---• --• ��- -- __•................ <br /> t <br /> qI <br /> --=----------------------------•--------------- -----•-- --------•---- ------------------------------------------------------------------------*--------- ------------------I-------------- -- - . <br /> -----------------------------------------------------••----------------------------•-------•--------=---------•---------•----------------------------------- -------•-------------:-------------------------------- -------- <br /> hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin.County <br /> ordinances, S+ to laws, and rules and regula '6n3�of..+he.San oaquin Local Health District, r I <br /> P11 1AAAii: -s t 3 <br /> _ y <br /> (signed) - -`- ---�- - =-r----------------------------------- --------(Owner and/or Contractor) <br /> .By - - ' ,. <br /> •--------•- ---- Title :. <br /> (Plot plan, showing size of)ot, location of system in relation to wells, buildings, etc., can be'placed on reverse side}. <br /> FOR DEPARTME SE ONLYt , <br /> APPLICATION ACCEPTED BY--------------- ----- r---------- ;------ --- -: --------- ..DATE----------------- <br /> - --------------------- <br /> REVIEWED BY-------------------------------------------- ---- = ----- ---------- <br /> DATE...:°' <br /> -------------=--------- <br /> BUILDING PERMIT ISSUED---- ----­------- ------ -------------- ------------------------•----------------------- DATE--:---------.------ ------ <br /> Altera+ions and/or recom endations------- - --- ------- -------•--•---'----------------------- 7-1----------------------------------------------------------- <br /> �- ---- - ----------------- - - <br /> _ -------------- _......_......_-- --------------- <br /> --------•-- - --- <br /> I <br /> -------------=--------------------------------------- ---- ------------- <br /> r _ ` <br /> FINAL INSPECTION BY:.-�.`-- ------•---------------- -- -----------------�--- � ^Date.-----1�-------+r--A-.. k� <br /> Fi + <br /> 11 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street A <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB-9 REVISED 9.99 F.P.c0.ZM 6.60 <br />