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... . ......... . <br /> APPLICI :)N FOR. SANITATION PERMIT I.111111100, Permit No. <br /> ......... _....-_..-- (Complete in Duplicate) <br /> Date issued <br /> ... ......... _._ This Permit Expires I Year From Date issued <br /> plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> s application is made in compl-iBance with County Ordinance No. 549. <br /> B ADDRESS AND LOCATION ' ......... ----------.-••--............................... <br /> mes's <br /> ---------------------------------- Phone...7_ f'-(G y4e__.. <br /> dress------ 44 ---------------------6 ... - -_ <br /> -------- -------- - - y- - --- <br /> ntractor`s Name "' --- = -�---_•�-- - ___.J. - - Rhone <br /> =aflation will serve: Residence ❑ Apartment House,C@ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -....... Number of`bedrooms ----le- Number of baths Lot size 3/-P._.a`i_l:d0--------------------_.............. <br /> ter Supply: Public system ❑ Community system ❑ .Private N Depth to Water Table _______-ft. <br /> 3racter of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam❑ Clay Loam I& Clay❑ Adobe❑ Hardpan ❑ <br /> vious Application Made: (if yes,date.............-------) No B New Construction.: Yes % No ❑ FHA/VA: Yes ❑ No ❑ <br /> 3E OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> >tic Tank:, Distance from nearest well---&U.-.f Distance from foundation..../ ..........Material".fir yL "_______._---.-_- <br /> _-_. <br /> No. of compartments-----_ ---------------Size-•---------_�___..__--- Liquid depth....--_---.._.._.._-.._. Capacify.al._�Fo•-ez..-_._. <br /> 3osal Field: Distance from nearest well.t'.,�LQ._/._._Distance from foundation.-©.!-______-.-Distance to nearest lot line... <br /> Number of lines_..-_._.....3 .._ .. Length of each line____fmt2f...... of trench__._.c)_V_"-_-_._._.._.__.-... <br /> Type of filter material.c _�_�c.�C•.-_Depth of filter material___._/-_g `-.__.Total length__ a.l` '.- 1_ �_.:..- <br /> F J <br /> -page Pit: Distance to nearest welL..,�aEf.......Distance from foundation../S ._._-_.Distance to nearest lot {ine./.Gl__f &� <br /> ..... <br /> N Number of pits-..__7�-------- ---Lining material_---............_._...Size: Diameter._ 'a_�r.._..--Depth_.....:2. ...._._."_---.----- <br /> .spool: Distance from nearest well.................Distance from foundation....................Lining material-_... _._..-___ <br /> ❑ Size: Diameter__.............­­..............Depth.................- .......___.............Liquid. Capacity....---------------...._..gals. <br /> y: Distance from nearest well......---------_"_.__-----_---_-----.---------Distance from nearest building............................. ._.._....... <br /> ❑ Distance to nearest lot line._....-.. -----------• - ............................. -­------------------__................ <br /> node{ing and/or repairing (describe):-_. -------- -------------- ........................ <br /> -------'--------•-------•---------------------'---•----•------------•------------------------------------------------------------------__-------- •-----•---•-•--------------------------•-------------------- <br /> -- --------------------- <br /> ------------------------------------------------------------------------------_---------•------------------------•--•--------------•------•---------------------•--- --------- <br /> I <br /> -------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ina State laws, andrules and regulatiogs of the San Joaquin Local Health District. <br /> nett . -•-•------ --•--.....----------•-•---._..__....--••-••-•-----------------------------.(Owner and/or Contracfo. <br /> B =------------------ - --- Title .. .-. .. , <br /> t pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 'LIGATION ACCEPTED BY_._/t'/Ji ----_. _ --------------------- DATE__ <br /> 'IEWED BY.---------------------..................• -- - ...................... DATE-....--- --------------------- <br /> _DING PERMIT ISSUED--------------------•-------------------___------------------------ ------------_..-------------- DATE------------------------ <br /> :rations and/or recommendations:.............___----------_--•---.---- ------ _- _---.-#___ �_ <br /> ---------------- •----- -------•---••.......----•----.-- �. ------- -- ----------- --------------.__...---•---•----.__...--••--.... ------•----•---•--....... <br /> ------- -...........................----....-. ­----------------------..._.._..- <br /> pD f ------------ ----------._....----- <br /> 'IAL INSPECTION BY:� .-.�r-._..�'_...` .- "�--------------•-- Date_.1_.�..M_ -^- � ................... <br /> .......................1----'--. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazolton Ave_ 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.0 o. <br />