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~- - 31 Permit No. <br /> � " <br /> 3 <br />-- _------------------------r-_._-_ _--___-__.__--_. APPLICATION FOR SANITATION PERMIT <br /> Com le#e in Duplicate)' <br /> This Permit Expires 1 Year From Date Issued Date Issued ---•-- •-`..... <br /> ... __ <br />_.._------- ------------ - -- - --- - _-- ► <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall +he wor erein described. <br /> This application is made in complian e with County Ordinance No. 549. <br /> saic <br /> JOB ADDRESS AND LO N -�. -._._ Q...-•-----. 4_.. 1.. . . <br /> Owner's Name-------•--- rC 11- 1 . 1 e--------�..A✓• C_�T-. <br /> -- Phone.................... <br /> -.. <br /> Address. <br /> ­� ---------------------------•------------------------------------- <br /> Contrac+or's Name-------••• Vic = t3 ----------------------- --- Phone-------------------------------•-- <br /> Number of livin �units�._:-___. N bei of n#`House ❑ "�Comrnercial ❑.� Trailer Court ❑ Motet Oth� ❑ <br /> �P <br /> Installe+ion will of l ving nuts: rn artm e�lrooms r _`Number of baths'__,____ Lot size .__._ -l______ _ ___ .rte, <br /> 1 <br /> Water Supply: Publics stem Commune system ,�Private De th'To Wafer Table ________ ft. <br /> Pp Y� Y �Y Y ❑J _ ❑ P <br /> Character of soil to a depth of 3 feet:(Sa'nd ❑ .Gravel',❑��struction: <br /> ❑ Clay LoamMo <br /> ❑ Adobe WeI�ardpan ❑` a <br /> Previous Application Made: (If yes,date;__ ______________I No YesM FHA/VA: Yes ❑ No <br /> 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Y._ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic k: Distance from nearestlwell_lDistance from foundation__Ill___r____`__.MateriaL __ _Y�_C_ _____________ <br /> EV No. of compartments______ _____-___Size___. �_l�.`fC ..-,...Liquid depth____�� Z..-______Capacity_ ___.______ <br /> - JJ__ _(-_____.Distance to nearest o,f�nes.___._...._ <br /> Dispose geld: Distance from near, t`'welll. �____Distance from found flon-(-�__ I I <br /> Number of lines------- Length of each line_` -_ _,�__�__-Width of trench-__1 q I <br /> Type ofilter material._�_--4r. �-: <br /> YP f-_ -------Depth of filter material -----#_Total length--/j1"V__--R.-_--..................... <br /> Seeps Pit: DistanceYto neare ell-t._,I _f-___Distance from foundation-.1 6_�____ Dotance to nearest lot fine_ __!_______- . <br /> Number of pits___ _ ____-�Liliing rrlaterial___W. Size: Di ........Dept + _________________________ �!h <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___.------------°__.Lining material___---_______ _-_________________ <br /> ❑ Size: Diameter.------_-1.2----------------- =----Depth-------•-----------•-------•---------------------!--Liquid Capacity ----------------------------gals. <br /> Privy: Distance from nearest "ell-------------------- ____'--------------------Distance from nearest building-----------------------.......-----------. <br /> ❑ Distance to nearestot`line �- -- `'` ------------------------------------ <br /> �. <br /> Remodeling and/or repairing describe)-��( ------------------------------------------ <br /> - ._ . <br /> ----------•-----•--•---------•----------------------------------•----------•----------------------------------:.._......_--•--------•---------------------------------------------------------------------------------------- <br /> 5_ <br /> -_---•--------------------------------------------------------------------------'---------------------------------------------------------------------------------------------------'-----••-------------------------------- � <br /> 1 hereby cert- a+ I hav epared this application and that the work will be done in accordance with Sen Joaquin County <br /> ordinances, State laws nd r s an r gulations of the San Joaquin Local Health District. ; <br /> (Signed) ,.. �---- -- ------------------------ € {Owner end/or Contractor) � <br /> a t <br /> BY:----------------------------------- (Title) G�%�-. . m <br /> {Plot plan, showing size of lot, ationiof system in relation to wells, buildings, etc., can be pieced on reverse side). <br /> 1 , <br /> FOR DEPARTMENT,USE ONLY <br /> APPLICATION ACCEPTED BY. � _=--- ------'-------------------- DATE..1. 6---------------------------- <br /> '-REVIEWED BY--------------------------------------- '--_- ------ ---------- --------- ----------------------------------------------- DATE---------------------------------------••----------------- <br /> BUILDING PERMIT ISSUED---------- -----�------- ----------�- -- ............... <br /> --- .�DATE---------------------.--------------------------------------- <br /> Alterations <br /> ----------- ------------------------- <br /> Alterations and/or recomm� dos: =` <br /> ------------------------------ <br /> ...................... � = j `f ---------------------------------------------- <br /> - - --- -• ... <br /> / '`. - -- ----------------------- ------- ---------------•--....- --------------.---•------------------------------- <br /> ---------------------------------------- ------- ----------------------- ------------------------------------- ----------------------------__-____-----___------------------------------------------------ <br /> - ------------------------ ------ ---------------------- -- -------------------------------------------------------------------- -•--------------------------------------------------------- --------------- <br /> FINAL INSPECTfON BY------- ------ <br /> .3- � <br /> s �................................ Date----------- -�-- ------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5.62 ATLAS <br /> F <br />