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FFiCE USE: <br /> 'R� /a...... <br /> ----- -- Ilk ----------------------- Permit No <br /> APPLICATION—FOR SANITATION PERMIT --_---_ <br /> ------- ------------------------------------- ---------- <br /> -- --------------- (Complete in Duplicate) <br /> --------- ---------------- ------------- Date Issued'_ �4/ <br /> ------ -------------- ------------- TRis Permit Expires I Year From Date Issued <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 y o. 549. <br /> t <br /> 1-2 <br /> JOBADDRESS AN L9CATI9N ------------------I------------------------------------- ------------------------------------------ <br /> 01. <br /> -- --------- ---- Phone------------------------------------ <br /> Owner's ----------- --------------------------------------------------------- <br /> Name - - - ---------- <br /> W, - -- <br /> ------------------------------ <br /> Address---___ACZ/ ---------------------- -- ------------------------------------------------------------------------------ -------------- <br /> tj �4,.- -------------------------------- <br /> Contractor's Namd------------ ---------------------------------------------- --------------------------- ------------ Phone' <br /> _ & - <br /> Installation will serve:-Residence-Z2--Apar+m,ent House [] Commercial-❑ T,r_616r Court Ma), [YOther <br /> Number of living units: Nuinbojofb'edrookt" N ----- Lot size 4-16 K /2 r--------•------------------------ <br /> _�rnm rty system E] Private El <br /> Water Supply. Public, system9�rC_. Depth to Water Table _&0 ft. <br /> Adobe M-1 <br /> Character of soil to depth of 3 fa -Sand-E]�-.Gravel [3 Sandy Loam [I Clay Loam [] Clay E] Hardpan F] <br /> No [?�—FHA/VA: Yes El No [9— <br /> Previous Application Ma'je":. (lfl`es,-date ------------------) No 9-� New Construction: Yes E] <br /> y <br /> TYPE OF INSTALLATION AND-SPECIFICATIONS: <br /> (No septic tank or cesspoc' l permifted-_if,public-sewer-is.,available.-w-ithin.-200-feet.)- <br /> Septic Tankon-------------------Material------------------------------------- ---------- <br /> �,, Distance from nearest-w;ll-----------------Distance from foundati <br /> ,15�G5, J-14.4 No. of compartments...... --------- Size------------------------'------Liquid depth------ -------------------Capacity---------------------- <br /> Di�osal Field: Distance from nearest well...!f=----Distance from founclation__Xe----__-----.Distance to nearest lot line..________ <br /> .. ......... <br /> 11 of trench.,,-2----------- <br /> Number of lines------- ------------------- Length of each line--s3,5..`.........-----.Width --------------------- <br /> Type of filter.maferial-4_ _/&94,*eDepth of filter material---• 6`-------Total length---Jr-4 ---------------------------- <br /> S6epage Pif-�­ Distance to nearest well-i--- -—-----------Distance from foundation___ -------"Dista n"ce to nearest lot line----- ----------- <br /> �w .1. Diameter--.171Y 11�11---m__.DepthA.0__` <br /> Number of pits--_-/--------- Lining maferiaI__,A-9P,4e0...Size: -------------------- <br /> Distance from nearest well-------------- .-Distance from foundation.......I---------- Lining material------------------------------------- <br /> Cesspoo : 9 ..... <br /> F1 Size: Diameter--------------------- - --------------Depth------------------`----------------------- ----------Liquid Capacity---------------------- <br /> . gals. <br /> Privy: Distance from nearest well-----------=--------------------------------- ...Distance fr6rn nearest building-_-_._____-----_-----__----______._--._. <br /> ❑ <br /> uilding----------------------------------------- <br /> F1Distance to nearest ]of line-------------- - --------- - ------------------- ---------------------------------------------------------------------- <br /> ------------ ------ ----------------------------- ----------------------------- <br /> Remodeling and/or repairing (describe)--=---------------- - ------ ----------- <br /> ------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------7--------------------------------------- ----------- ------------------- <br /> ---------------------------------------------------­------------------:_­------- ------------------------------------------------------------- -------------------------------------------- ----------------------- <br /> ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I 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 regulal-io'ns-of the S_an-J;1iu-1n L&EaIrHWaltklNl_stric+. <br /> Ile <br /> - -- -----------------------------------._,tQwn;er_-ancVor Contractor) <br /> (Signed)------------ - ----- <br /> ................ --------- <br /> ;fc., can be placed on reverse side). <br /> By:------------------------------------------------------------------ -- <br /> �,jr(plot plan, showing size of lot, location of.system in rel i to wells, buildings, <br /> V FOR DEPARTMENT USE ONLY <br /> ----------------------------- <br /> 4''.APPLICATION ACCEPTED BY-------' ----- -/f ---------------------------------------- DATE__7_ ---- <br /> .REVIEWED BY-------------------------------------------------------------------------------- ----- -------------------------------------- DATE----------------------------------------------------------- <br /> -------------- DATE_.---------------------- <br /> ------- ---------------------;:------ <br /> -------------- <br /> BUILDING'PERMIT ISSUED------------- ------------------------ <br /> nd/or recommendations:__._... `,- ------- <br /> Alterations a <br /> A, --------------------------------------------------------------------------------------I—_---------------------- <br /> ---------------- ------------ ---------------------------------------- <br /> ----------------------------------------------- <br /> --------------- ------- <br /> ----------- ------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------- ----------- ------------------------------------------------------ ------------------- -------------------------- -------------------­------- --------­--------:--------- <br /> --------------------------- ------------------- ----------------------------------- <br /> --------------------------------------------- --------- ------------------ ------- ----------- ----------------------------------------- <br /> ------------ ------------------------------------ <br /> FINAL INSPECTION BY:---- ----- --------­-------------- Date------- <br /> -------- --- ----------- <br /> SAN J6AQUIN LOCAL HEALTH 'DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 RrVMED B-59 31A 3-*63 F.F.00. <br />