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rvrc vrn�c ux: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> . .1- --- <br /> (Complefe in Duplicate) <br /> Date Issued <br /> - - -----------------------_----------.... This Permit Expires 1 Year From Date Issued <br /> LApplication is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. t <br /> 1 JOB ADDRESS AND LO�CATION._L//✓!V_ 46 I\_ s-1 y �-' 1 -¢ ---�(--fes r/--- -� . <br /> sr Owner's Name - "T ` !-- ._W47F ---- __ -.-- Phone-,.,' - <br /> -- Address.._. .. .. -- ---'---- ---'-" <br /> i - -- Phone i�L-SiO /? 7 <br /> � Contractor's Name.---_._�'!'�_:2 (-.S-(1 _-�-±�`�.� -- -- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1--_ Number of bedrooms _Z.-- Number of baths .(----- Lot size ...-,.Ae64` r ------------------ <br /> Water SuPPIY° Publics stem ❑ Community system El Private`� Depth to Water Table 1,57"Tt <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam K Clay ❑ Adobe ❑ Hardpan ❑ <br /> ` Previous Application Made: (if yes,date___- -__.. I No X New Construction: Yes ❑ No V FHA/VA: Yes ❑ NoK <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> - - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C- <br /> us Septic Tank: Distance from nearest well ----------_-Distance from foundation--------_.--------.Material --------------------_--.--. <br /> 06bS+1144' No. of compartments-----------------------Size------------1---------'-------Liquid depth.----- ----- ------Capacity----------------- <br /> Disposal Field: Distance from nearest well_tP1--'r -�-__Distance from foundation_ ,X. ____ Distance to nearest lot line-..�.-�_-_ <br /> L. �• Number of lines._ ' �----.-.Length of each line.,__. -_ /fi ---f <br /> -�'yt,,Q::1.-f_ � +'�-�--r_--------Width of trench-_�:�-'--------__--------- - <br /> Type of filter material--R-V --.-.-Depth of filter mateciaL_-_/.-p-----_-_--Total length---Z T--.-------------------- <br /> - Seepage Pit: Distance to nearest well--15`0-t--._-Distance from foundation_-14V-__--_. e to nearest lot line--.' _f--_ <br /> ` Id Number of pits-�j1.(.Q-Lining material--, _ Size: Diameter-_: ------Depth- .----- <br /> Cesspool: Distance from nearest well Distance from foundation---........_---_Lining material------ --------------- ---------- <br /> L ❑ Size: Diameter- .- Dept h----.--- -- --_----- -Liquid Capacity... --.-----.---_---gals. <br /> Privy: Distance from nearest well --.--_-.-----------_ --------------------Distance from nearest building__---___---------------------_.. <br /> ❑ Distance to nearest lot line. - -------`------------------------------- ------------------------ C <br /> Remodeling and/or repairing (describe):_ :_,_1- __--._._-.rP.-. , _-- � ------- - <br /> ---'-'------------- <br /> �. ----- - --- -- - - --- - - - <br /> - ------------ -------------------- f- ---------- - - - - - - - - ---- <br /> - - ---------------------------------------------------------------------'------ -------------------------- ---- -------------- ----------- --- <br /> I hereby certify f I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I s, nd rulesand reg ations of the San oaquin Local Health District. <br /> (Signed)_ .. - 44 - _:- - - - ---.- --- - - -- ---- - ----- __.(Owner and/or Contractor) <br /> ' - - - „. - - ------ <br /> By:(Plot plan, showing size lot, location of system i relation to wells, buildings, etc., can be pla d on reverse side). \ <br /> FOR DEPARTMENT USE ONLY <br /> p APPLICATION ACCEPTED B - - - - - ----- - -------------------------- .- ---- <br /> L REVIEWED BY - " -- ------ <br /> B <br /> -- - -- -- ------------ DATE----------------------- - - - -- - <br /> - -- --- <br /> BUILDINGPERMIT ISSUE ------------ --------------- -------------------------------- - - DATE.. - - -- — -' <br /> Alterations and/or recommendations:-------------- ----------------------- ------------------------------------------------------ ------------------------- <br /> ----------------- ------- --- - - - ---------------- -------- <br /> ----- ----------------------- ------------ <br /> FINAL INSPECTION - - - - ---- Date------- -�c7-`1 -- --------------------------- <br /> S N JOAQUIN LOCAL HEALTH DISTRICT <br /> ,an, [ Y...Jtr.. A... ann w...,/b.L u...., ,OA e... e. • ........ _.• _- <br />