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4 VJL; <br /> APPLICATION FOR SANITATION PERMIT Permit No. ------- __.__.- <br /> t;-. <br /> -----� ............... .............. (Complete in Duplicate} <br /> .......... <br /> .............. <br /> '-"' . This Permit Ex fres 1 Year From Date Issued ''' Data: Issued .la .�r.. <br /> Fpplicatiori is hereby made to the San Joaquin Local Health District for a permit to consfiruct and ' Ile wor herein described. <br /> anis application is made in compliance _ h County Ordinanc No. 549. �U ct <br /> i r <br /> ADDRESS A D LO, <br /> ATION <br /> B.� , /� - �/ r ------- I <br /> ► er s Name..&!_a..�' !2:'��C..�_._." " � �.. �. .i>< <br /> �` -- . <br /> . . . ............. .... Phone--- --------•----------•---•-•--•--- <br /> �dd�iess--- ---------------- . <br /> 1 - �._ <br /> �_. � �. <br /> ontractors Name / �` <br /> b� <br /> l _.._..--•-�•-•� <br /> ------.....---:. ..:. .. :4�C'1� .._.....�10 <br /> .. Phone ._w .� ._�_ , <br /> nstallationwill serve: Residence Apartment House �❑ Commerci I ❑ Trailer CouMotel ❑ Other [:1 <br /> Number of living units: ___T Number of bedrooms ._ Number of baths -.�..,. Lot size 7 <br /> ;ate Supply: Public system E] Community system E] Private�pth to W ter Table .rS.. it. <br /> :haracter of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam JEr Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Fevio�us Application Made: (If yes,date....----- ---- No 91"' New Construction: Yes to ❑ FHA/VA; Yes ❑ No ❑ <br /> 'PE'GOF INSTALLATION AND SPECIFICATIONS: <br /> 11 (NolIseptic tank or cesspool permitted if public sewer is available within 200 feetwo <br /> .) y <br /> F.,pfic Ta Distance from nearest well �`� _Distance from fo dation............... tarial__._� '-.................•----- i <br /> j / / `�' 9 r <br /> No. of compartments...' .---•._._._-,$ize _.. .x}� k_. Liquid depth-. �._.�..._......Capacity..,j. ',�*--- -- Gn � <br /> )is osal Field: Distance from neare t well: ..Distance from foundation.._.. ..... I <br /> l <br /> P .....Distance to nearest lot Ii <br /> Number of lines__.... .......... .. Length of each line._�7x-_f�7_ 4''Width of trench..ra `'`L. .-.-.� --_� <br /> Type of filter material._..... . . Depth of filter material_---.-� ._.__. _ _ <br /> i <br /> i <br /> ee aDistance from foundation-------------------- oistancengohnearest 1 <br /> Pit: Distance to nearest well..•.'..._._... of line__'.-.'.'....... <br /> p .ge Pil <br /> Number of pits......:...... Lining mpterial...... ...............Size: Diameter_ ............. Depth........................ <br /> ......._. s <br /> `.asspool: Distance from nearest well-----------------Distance from foundation... .........Lining material-.-............ <br /> .._ . <br /> Size: Qiameter- i <br /> - • ------------- ---_---------Depth-------------- --.-:_Liquid Capacity.-------------' ...........gals. F <br /> ivy: Distance from nearest well............ - g- <br /> ....__Distance from nearest buildin <br /> j „' Distance to nearest lot line.. ------ <br /> .remodeling' and/or-repairing {describe':.--._.._. <br /> --._._.. ---•-----••-----•-------- --' <br /> ------- r------•-............. ”--- ------------------ -•-- <br /> hereby certify that ave prepared tJhis application and that the work will be done in accordance with San Joaquin County <br /> t dinances, Stafe laws, arpiles and regulations of t n Joaquin Local Health District. <br /> ;$ j' tr"TRNK""S R�tIG'E=.... .....&atjfo <br /> ......•--...................... Contractor) <br /> ed) 2915 E MinerAve.; - HQ.6-8841 <br /> Y' •-------...--•---------••-•---------•---- •-------....•--.--. !welils, <br /> �•-------_------_---------(Title)....--............. ............ ............. ... or <br /> 'lot plan, showing size of lot, location of system inuildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> PVIEWEDI <br /> ON ACCEPTED BY.. 'c. .,. C " - DATE...... <br /> SY---- ------••--- - . '----- •......................... •...................................... ....-----....-•----. ----- DATE..... <br /> Item+tans and/or <br /> ISSUED..................................................................._.. DATE ----- <br /> ILDING P <br /> recommendations:............ ....... .. <br /> ............................................. <br /> . <br /> i ........ <br /> ..................i..-.._............. ._........._.-.-. .... , <br /> ....... J.:. ....................... ............................................... . <br /> .ANAL INSPECRQLL .. Date........... ..... <br /> .......... ............. i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT F <br /> r ♦_ 1601 E.Ha:ellon Ave. 300 West Oak Street I24 Sycamore Street <br /> 205 Wes!9th street <br /> Stockton,California Lodi, California Manteca,California Tracy, California <br /> F.P.C❑. <br /> L :h i <br />