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rUK UFFIC:E USE: <br /> ------------------ -------------------------------------- t 4- <br /> .__.________ -----____----------------- ----------- _ APPLICATION FOR SANITATION PERMIT Permit No. .V/.. f:_41?2t5_ <br /> ------------ --- --------------------- --------- i (Complete4 buplicate) <br /> -_ .----_ _ -- <br /> _..__.._._ - --- ----------._-__.___._ .._. This Permit Ex ices 1'Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District - a��errrii"t toiconstruct and install the wort herein described. <br /> This application is made in compliance with Cgunt Ordinance Nq. <br /> JOB ADDRESS AND LOCATIO S1iC _ �---- - ] --- A -- J '---------- <br /> Owner's Name----------------R_)_Pn _"� 1.,� Q------ � Phone <br /> Ad > Q ----------- <br /> Address_------------- �� -� -`------------ <br /> � <br /> Contractor's Name------ -- F--R---------------• ----------------------•--- ------- ------- ---•------------ ------------------ Ph - --•---------------------- <br /> ck 0 r=Aj "0Vs�: <br /> Installation will serve: Residence E] Apartment House ❑ Commercial E] Trailer Court otel ❑ Other <br /> Number of living units: _- ----- Number of bedrooms ........ .Number of baths _._____ Lot size __i.AC R�A c5�_______________________ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 1__ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [*Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date_........ ........ ) No�>,New Construction: Yes 2_1q0_ E] FHA/VA: Yes ❑ No <br /> 1 <br /> TYPE OF:INSTALLATION AND SPECIFICATIONS: ;; <br /> (No septic tank or cesspool permitted if public sewer isYailable within 200 feet.) <br /> Septic Ta k: Distance from nearest well__. ._Distance from foundation__._!------ Materi I __� !G'.R-1= <br /> [ No. of compartments__.__Z—-------.....Size__3'-,X_�_aC.-j Uquid ��cl7epth._-f Capacity.._�por_-.___ <br /> Disposal Field: Distance from nearest weil../,00 Len ath e' from foundation----/C.�--__.___.Distance to nearest lot line___�__.__._._ �I <br /> Number of lines ________ ___ ____ ` I r <br /> ©� g of each line-- ----- /_-Q )< Width of trench--------- - ---f----------- <br /> Type of filter material._1q0.C-.4'\,_ Depth of filter material-------le7.____.__Total length_______- -------;? "A <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______._.._._____._.________________ <br /> ❑ Size: Diameter ._R:s_ ____ <br /> y p ------ �� ___ --i--Liquid Capacity---------------------- -----gals. <br /> ---------------- <br /> Priv Distance from nearest well______________________ <br /> Depth <br /> --- Distance from`nearesf building--------------------------------------- <br /> 0 Distance to nearest lot line 4- -- '- ------------------------------------ -------------------------- <br /> Remodeling and/or repairing (describe):------Fl.A TES-______2 <br /> ___1rRrr---------1VAdmsA!_+4 - ---------------- <br /> --------------' <br /> -----­1----------------------------------------------------- <br /> ---------------------- <br /> I hereby certify that I have prepared this application and thatithe 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)--- L �" - -------------------- ---- --------------•----------- ------ (Owner and/or Contractor) <br /> (Plot plan; showing size of lot, location of system in relation to wells, buildings,etc. d (T;tlt:)------- --- -- -- <br /> Y - -------- ------------------ _ - -------- ------------ --------- <br /> I i4 placed on r erne side). T r <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--.-. ---------------- ------ --------------- y: =------ ----- DATE----------- �- -. -- ---------- <br /> REVIEWED BY----------------------- • - ----------------- --- -------------- --- ---- - --�------- ---------=:--------•- ----- DATE--------------- --------- -----------•---------------------- <br /> BUILDING PERMIT ISSUED-------- ----------------------------------------------------------------- _- ------ DATE <br /> Alterations and/or recommendations:---------- <br /> --- ----- -- - <br /> - - _- ---- .._ . ------ _-- -_-- - __-....:..__ _u.-. -- <br /> ------------ <br /> FINAL INSPE -------- ------- Date---- _---------- � `��-------- - -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haielton Ave. 300 Wast Oak Street 144 Sycamore Street 20.5 West 9th street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.92M 1-67 Vanguard Press <br />