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FOR OFFICE USE: <br /> .... fid.. APPLICATION FOR- SAIITATION PERMIT Permit No. _. ¢ <br /> ------------ --..------.------ --- ..._...... <br /> .. <br /> _--.,_-----------_.._. ----......._-.-._._...._.--. (Complete-in Duplicate) Date Issued //.c.a.a.moma/ <br /> _.----------- .............. This Permit Expires 1 .Year From Date Issued r�Z�3D _p7 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct end install the work herrei�jdescribed. <br /> This application is made in compliance with County Ordinance No. 549. /l3C�Ti <br /> F JOB—ADDRESS"AND LOCATION:`: � ' 40_00001 <br /> Name------J�l��6lJ � '�.&....i6��'r IYJ.D--- ------------ -----.--............. Phone---------------------------------- - <br /> t <br /> Address. A ....................................... ... <br /> Contractor's Name...... . ... - ...... Phone-----..-_------------------------ <br /> Installation will serve: Residence Apartment House ❑�A Commercial E] Trailer Court ❑ Motel El Other 13( ;Number of living units: . ... Number of bedrooms A.. Number of baths-A- Lot size/09V'*�.-----------.. --- - -.--- - <br /> Water Supply: Public system ❑ Community system ❑ Private 9RO'Vepth to Water Table lQ_ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ElClay ElAdobe ❑ Hardpan [jI Previous Application Made: (if _ _ K/ <br /> f yes,date - .............. I No New Construction: Yes S@00no ❑ FHA/VA: Yes g�-' No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` <br /> t <br /> Septic Tgnk: Distance from nearest well.... ®......Distance from foundation.. �.........Mate�al .../��r 9..�.j.................. <br /> E ®/ No. of compartments_.-_ ..............Size...Z�.-K ... X3Liquid depth.. ....... ........Capacity <br /> .2f.pO...... <br /> i <br /> I Disposal Field: Distance from nearest well Q rDistance from foundationa�_o......Distance to nearest lot line��...... <br /> ®/ Number of lines _.._.�--._. .._ Length of each line..."evp----------------Width of trench.r-'-L--.�---.____.....__-----I <br /> th of filter material.....�aP��- Total length_. �0-- <br /> Type of filtematerial f ./ j1 o p ................. <br /> r <br /> Seepage Pit: Distance to nearest well__...}..'.._........Distance from foundation_----.---------.--.Distance to nearest lot line................ <br /> { ❑ Number of pds_..................--Lining material.............:---- --- Size: Diameter__.- Depth................--------......--- <br /> Cesspool: Distance from nearest well'.............Distance from foundation................. . Lining materiaL.- --------- -------_.............. <br /> . <br /> ❑ Size: Diameter- -- ..........t' ....Depth.................._-..._....-... -------------- Capacity_----------- ----.-.-----gal <br /> s. <br /> Privy: Distance from nearest well.................................................Distance from nearest building---__......................... <br /> .........-. <br /> ❑ 1 +. <br /> Distance to nearest lot linve�...�.................---'------------- -------------------------------------.-.................-.-.--........----- <br /> Remodeling and/or repa ting..(describe)` - - <br /> G+X11---- -------------------............----_- ----- <br /> ---...... .....................�4.......------ --------- ----------...................................... <br /> ..........-.-............--...- ......_-._-.---- --------.-...----...- --- -------------I................... <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 /> ordinances, State laws, and rules end regulations of the San Joaquin Local Health District. <br /> (Signed).---- /..(/ -✓ � -1 G ... . .. . - - --'...._-........_................_..(O nev Connector <br /> --........ !(l/. - -- - itle)...�!?�✓ -............-_ <br /> BY:.......................... - <br /> . - - - - t1 <br /> (Plot plan, showing Size of lot, location of am in relation to was,buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY_.."-_.I. <br /> APPLICATION ACCEPTED BY-- - ---"- . .......................................-. ..- DATE..... .............. <br /> . <br /> -- -- - -_ <br /> REVIEWED BY--- -- -- - ----- DATE--- ---�-------- <br /> BUILDING PERMIT ISSUED.........................._............ ------- . DATE------------- ------- ----------- <br /> Alterations and/or recommendations:..--_......__..................... ....................*.................'----------------.------------_. --`----------------- --------- ----- ---- <br /> ................................... ......................................... .- ----------..........._ -­------------- <br /> ........................_...................... .... ---—..................................... <br /> ..--- <br /> FINAL INSPECTION BY:_ .!__ .............................. Date-..... - d -- ---- -- - ... ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ......�" <br /> 1601 E.flattener,Ave. 300 West Oak Srreet 124 Sycamore Street `W 20S'Wetb9t8'Street <br /> Stockton,California 1.01, California c Manteca,California Tracy,California <br /> E.X.9 2M 1.67 Vanguard Pro <br />