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_---------- -- --------- <br /> APPLIC��7N FOR SANITATION PERMIT Permit No. _ ..-....__.._._.__ <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> t"applicafion is made in compliance with County Ordinance No. 549. <br /> /ADDRESS AND LOCATION----�''-* ...... --------------- -------------------------------------........... <br /> ,-er s ---------- -------•-= - r.._ - —...........--•---•-------•...... --­----­------------ Phone- 1— --------­---- -•-- <br /> dress- Gb .- - -I = � H1r-1 - <br /> - - - --- <br /> - <br /> --•-----•-----. Phone- -•------ <br /> ractor's Name........ --• .-C -.• <br /> "41lation will serve: Residence ❑ Apartment House,® Commercial ❑ Trailer Court ❑ Motel ❑ Of her ❑ <br /> Number of living units: .. Number of'bedrooms ----4. Number of baths c�L Lot size --------------___________•.__.. <br /> ,fir Supply: Public system ❑ Community system ❑ Private K Depth to Water Table -------- ft. <br /> aracter of soil. to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam C- Clay ❑ Adobe ❑ Hardpan ❑ <br /> pus Application Made: (If yes,date....................) No 5§ New Construction: Yes tK No ❑ FHA/VA: Yes ❑ No ❑ <br /> 4V OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 240 feet.); <br /> c Tank=-,- Distance from nearest well.-W-O.._s Distance from foundation..../0 2.____.Material-_._de)l4 "______________________ <br /> } No. of compartments---­ -.--•.- _-----.Li Liquid de th...___._......_......... Ca acifi 4 1Eo.ca....... <br /> p .__.----Size------•---••----------•- q R p Y- <br /> �nsal Field: Distance from nearest well.%_ZQ:.. ..._Disfance from foundation•�4_f_.-.-_--.Distance to nearest lot line-..-9�_........ <br /> Number of lines... �. - _. _-- Length of each line_...fmC1.X......._._..Width of trench----.o�-�"____._.._ <br /> Type of filter rraterial.c�.,'.zl EC.--Depth of filter material—­_/ length__, D_? j <br /> S_.:... <br /> r i <br /> nage Pit : Distance to nearest well...,'t►L 4?......_.Distance from foundation--/ ._.__-.Distance to nearest lot line./a."�..... <br /> Number of pits.___-..-_..__. __Lining material___..-------__.__.....Size: Diameter_.3"`�_._...__-._Depth.._._2.5.°............._. <br /> Spool: Distance from nearest well________________Distance from foundation-..-------------....Lining material------------.--_.___---_._____--____ <br /> F1 Size: Diameter---- - ------------- •.. .......... Depth-------....................... -----.......Liquid. Capacity-----------------..........gals. <br /> Distance from nearest welL..----------------------.._-____-....._--.-_.-Distance from nearest building.......................................... <br /> _] Distance to nearest lot line......... - --••----------------- --•--------• - - <br /> )deling andfor repairing (describe):._.---- -------- --------•-•-------------------•-----------....................._.._._.............................................................. <br /> -------------------------------- --• --------------------------- <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 /> >s!a State laws, and rules and regulations of the San Joaquin Local Health District. <br /> :dj - - •..................... ---------------------------------------- ----- towner and/or Contractor) <br /> $y:----------------•----------------............................................•-•-------------------------- ....................Title} r <br /> t plan, 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 /> 'LICATION ACCEPTED BY---..'-Z' ' - - .- ---------------------------------- ----------------- DATE--I-�-�------�`t.--�- ' i' <br /> WEDBY-------------------- ----------------------------- ----.. DATE--- ----.. ...... - <br /> ,,}tNG PERMIT ISSUED-----------------------------------------------------------•---_----------------------------------- DATE--------.-.-------•-•--•------ <br /> :rafions and/or <br /> u <br /> recommendations:--------------------------------•--- --- - ------- - v� <br /> -------------. ....................... ----- —319.........- <br /> ----..._............ ----•--•---......................... <br /> ------ ............ . .•-•-----.---._......._....... ..._ <br /> - •-••••--.........•---•-...•----........---------•----•-• ---...... <br /> ��Qpp D r ` •--•--------..........­1----------- ------- <br /> '�AL INSPECTION BY:��...�...__."".._` .. .- Qate...t I —10^ 6 7 <br /> .......................•----...._---•--•------- ...................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> u 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r.P.CO. <br /> W <br />