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-� - ego , o� <br />,fly' PPUCATION FOR SANITATION PERMIT i <br />o �plef�i Duplicate) <br />077-- Y70 -2Z <br />Application is hereby made to the San Joaquin Loca! Heath D'strict f r a p„it o ` ruc+ nd i tall t e work erein described. <br />This application is made in compliance with County Ordinanc o. 54 <br />�p SCO /✓' • . <br />JOB ADDRESS AND XOC TION------ - +-----: ---------- -._----------------------- --------------- 7-�- I --- <br />Owner's Name- !! - ------ -- -- ---- --'------------"-------------------------------- ------------------- Phone ------------------------------------ <br />Add= r '---- --------------------------------------------------------------------------------------------f-------------------- <br />Contractor's Narne__._k_,�rf'-----., ���'�'""'--------------- -- Phone_..L_--f ------ <br />--- - -- <br />CN <br />Installation will serve: Residencex Apartment House ❑ -Commercial ❑ Trailer Court ❑ . Motel ❑ Other. ❑ <br />Number of living units; Number of bedJI-XI Number of baths 0 Lot size_ -7o__ _ __�_�__7X_X_! � <br />Water Supply: Public system ❑ Community system ❑ Private_ <br />i <br />Character of soil f a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Y Hardpan ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) ft <br />Septic Tank: Distance from nearest well ---- 6,0...... Distance from foundation ------ /.j%___"__.Material---- 6o ­4c 14-'�______________ <br />of compartments --------- ----------- Capacity ---- 97 fid --_____Size__- - L ,r _Liquid depth_,S- ............... <br />Cesspool: Distance from nearest well_________________ Distance from foundation ------------------- Lining material -------------------------------------- <br />1-71 Size: Diameter -------------------------------------- Depth ----------------------------------------- <br />Privy: Distance from nearest well______________________________ <br />❑ Distance to nearest lot line ------------------------ <br />______________Distance from nearest building ------------------------------------------ <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 />f <br />.Disposal Field: Distance from nearest well -------- Distance from foundation____e_______Distance to t5earest lot line____________ <br />Number of Lines____________ %r__ ________Length of�each line ---- I_o <br />------- Width of trench ----- '_----------------- <br />Type of filter material Depth of filter material _�--_____ <br />Remodeling and/or repairing(describe)--------------- a�,�-— <br />-------------------- ---------------------------------- <br />----------------------- --- <br />1!------- -� <br />---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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, State laws, and rules and' regulations of the San Joaquin Local Health District. <br />(Signed)t ,f`'' 1/.---""---------------------------------------------------------------------- ((w+�er.a*d/or Contractor) <br />By:---Er-----------------------------------------------------------------------------(Title)--- ----------------------- <br />(Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY_ -____f____ <br />REVIEWED BY---------------------------------- <br />BUILDING <br />----------------------- '----•'BUILDING PERMIT ISSUED___ ------ ,__________________________ <br />Alterations and/or recommendations________________________ <br />-------------------------------------------------------- -- DATE------- t <br />----------- -------------- DATE--------------- ---------------------------- <br />----------------------------------------- <br />--------------------------------------- DATE------------------------------------------------------------ <br />------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- <br />-------------------------------------------------------------- _-_-- ISSUED------------------------------------------------------- --------------------------------------------------------------------------------------------- <br />PERMIT No.-- <br />' _�� ___________(Date) FINAL INSPECTION BY: --- /16'_f'.° ._______ <br />_ ___-- -V-_ --- ----�___-- <br />--------------- <br />Date--------------- ----------------------------------------- <br />,t <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street <br />Stockton, California <br />E5 -4-2M 9-50 W=1639 <br />