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FOROFFICE U_SE: <br /> ----------.------------------_- - - <br /> --- -- ----._- <br /> AerLICATION FOR SANITATION PEI�.t1T Permit No. 3 J <br /> ------------------------------------- ----- -- (Complefe•in Duplicate) p <br /> Date Issued <br /> -------------------- -_._ _....--_.- -...........__ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in Comicge with County Ordinance No. 549.JOB ADDRESS A D LOC '.. YIIR.R...1- � ,�L F - �j/dl/ -----5(p...................... RAF <br /> Owner's Name. Qp�-„>r- l.� rS--------�j-<l .-a.. - - -- - Phone .................. -... <br /> 146.11K1 FR wA.... Z-- b �frrt4t .P- - ------------------ --------- <br /> Address. .� <br /> Contractor's Name_.V-.&N.KM--------------••-.................-------------------------------------------------------.....- Phone-----.....-•----------•-------••- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial [j Trailer-Court eMMotel ❑ Other ❑ <br /> Number of living unifsO - Wmber of bedrooms -4--- Number of baths-_ Lot size .ACREA.G.JF. ..............__.--...__ <br /> Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table )!9- ft <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑❑] <br /> Previous Application Made: (If yes,date----. __-------- ) No New Construction: Yes ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - �l <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well.---.✓��'_.Distance from fou dation.-------/....-Material CVIKAF-r�.___(3L- <br /> S No. of compartments--_Z-.._--------Size_6.).0 -X- _....Liquid depth.... ..-.._.Capacity..e ->�-..8_P.. <br /> Disposal F' d: Distance from nearest well--J-0.--.-Distance from foundatiggpp..._�------------Distance to nearest lot line.... .---.--_- <br /> Number of lines.........I.._....._-_....._Length of each line.. ..7Q-__�._ Width of trench..---...IO--.-,------�-___. <br /> Type of filter material...�.QCK-----Depth of filter material...__.lty-.____---Total length----_.-._-.---------Q,--.---.-.-. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------..------..- <br /> ❑ Number of pits.-.-------..--_.--Lining material--.-__._-_..._..--- Size: Diameter.......................Depth----.--_.._--.--_--------__-_� <br /> Cesspool: Distance from nearest well -..............Distance from foundation----------------- ..Lining material----------------_................... <br /> ❑ Size: Diameter. .. .............. ................Depth--------------- ------------------------------------Liquid Capacity-------------------_-_--gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building......................... <br /> ❑ Distance to nearest lot line_------------------------------- ---------.......................................-...................................... <br /> - - <br /> Remodeling and/or repairing (describe):-------------------------------------__----------------------------------------------------------------------------------..................... <br /> ...- <br /> -----------------------------------------.......------------ <br /> ---------------------..-.._......---.............-----------------`..----------------------------------..........-------...... --...................................-......-................................. ((............................................................. <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County C <br /> ordinances, State laws, a les and regulations of the n Joaquin Local Health District. <br /> (Signed)..... +-,I '-------- ----------- -- - - -------- . ..----- ------ ---- ----------- ----------------------------- ----- - -----(Owner and/or Contractor) <br /> By:..........................................-............................................ ....................-...........___(Title)----------------------------_------------------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTM NT USE ONLY <br /> APPLICATION ACCEPTED BY------- 'F .O.--.... - ............-- -­--------------------------- DATE...... ----2 ._AZ-"----------...... <br /> REVIEWED BY.......---......-F-...U-ONDER..HAA.R:•---------------...----------------•-----__----------- DATE.--.. ..-Z.. .�Z-................_-------- <br /> BUILDINGPERMIT ISSUED.---------------------------- ---......................._..................................--. DATE---------- --------------- .-......-......... -- <br /> Alterations and/or recommendations:_------. .......... .......... ......----------------------------- --•----•-•----- --------.................................. <br /> ..... <br /> ......... ......... - --- --- ------- --- ---- --- - - - - . .... . ........................... <br /> -- ... _. <br /> _... - --- - - --------- -------------------------------------_-----.....-------------------- <br /> AN <br /> ---- - - -- <br /> FINAL INSPEC -- Date-------- ���7 -- - _.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Maselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi California Manteca,California Tracy,California <br /> E.M.9 2M 1.67 Vangoard Peas <br />