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CATION FOR SANITATION PEf Permit No. <br /> ----- --- - ----- � (Complete in Duplicate) <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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__-_. CCl � Z.. � � /fCGtJ__1�,.Q _____________________'. <br /> _T______________4---_..-__. <br /> Owner's Name i� �1=?"f 1,4 - - Phone � - <br /> Address ---------- .-- .�C- �-3 ✓ r--121 , -Ca, '------------------------------------------ -------------------------- <br /> - .Y <br /> Contractor's Name--- �,= ✓�'�s ,�rd�fSy �t >--------------•--•----••---- Phone----• =� ---g1"_7 <br /> Installation will serve: Resid�nL�e 'A zb tment House Commercial Trailer Court Motel ❑ Ofher ❑ <br /> I p ❑ ❑ ❑ <br /> Number of living units: _ .-___ Number of bedrooms _ .. Number of baths ___rt` Lot size __ ._-.-.__.___._--_-__-_ <br /> Water Sypplj,.',,Public'Vstem ❑ QvmoJ�ty_s stem ❑ Private Depth to Water Table .ft. <br /> Char4cti -�f soil to at depth of 3 feet: Sandi ravel ❑ Sandy Loam* Clay Loam [Q Clay Adobe' Hardpan ❑ <br /> Previous Applicatiori Made:' (If yes;di< e - _ _ ..._�'. ...) �15�"-i�f onstruction: Yes %ab <br /> o FHA/VA: Yes ❑ No <br /> I l`TYPE OFINSTALATION A(jD•\S ECIFICATI0 `(No septic tank of cosspool p mitted i c er is availableithin 200 feet.) <br /> Septic Tank: Distance from ne test we .._._Distance from foundation_..._ / <br /> No. of compartm __ -_- --------- Size--_�Z�?Q �� _Liquid depth----- Ul_-__---Capacity/�.9.�/ <br /> Disposal Field: Distance fro are wQ_�_Distance from folkid !._ :. - Dista ace'to nearest lot line___.________.... <br /> Numb e lines_________ _____________ ___Length of each line_ <br /> �e -�_ ---------Widtkol trench-------2 // <br /> T of filter rial--- _ -- ___ .__Depth of filter material__ le&-.--- otal length--------.X .tQ_.---____-_._....__ <br /> Seepage Pit: Distant nearest well---------------_......Distance from foundation--------------------Distance to nearest lot line-------.---_-_.-- L <br /> ❑ NN mt�er of pits----------------------Lining material--------- -----------.Size: Diameter---------- ------------geRth------------------------------ C <br /> Cesspool• Distance from nearest well-----------------Distance from foundation___.____ .__._ Lining Tee 4 ----------------------------------- <br /> Size: Diameter----- --------------- �` i1 -•- <br /> ❑ ---------------Depth---------------------•---- --- -- --- --------•--•-------•--gals. � <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest bui clingj___ __..__..____.__.______ ____...._. J <br /> ❑ Distance to nearest lot line------------------ •------------ rt� ----- -------------•-•_------------------ --- --------------------------- <br /> Remodeli g and/or repairing (describe):.-___ /lS. -oT --- ~-- -- - ---- IA?,-0011_247 <br /> x���f .tr .. rr-,6� c ,rl� _,rs --«a �n�� / s , ----- (,�� <br /> - ,,,tom <br /> ---,�.l�an---amu � �j -- � <br /> - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------- ----- <br /> 1 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 and regulations of the San Joaquin Local Health District. <br /> G <br /> (Signed)------,L/'-�--- -- C.S . - - (Owner and/or Contractor) O- <br /> By:----------------- - -- ----- - -- - -- - - -- ---- ------------------------------------------(Title)-- -?- ----- ----... - <br /> (Plot plan, showing sit a of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--_----------------- - -- - ----- --------------------------------- --:-;-- DATE----- -- - -------------------------------- <br /> REVIEWEDBY--------------------------------------------- ----- ------- ------------------------------------------- DATE----- --------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> 't <br /> Alterationsand/or recommendations-------------- --_----_----- -----------------•-----•------------------•-------•------•---•---••-----•-----•----------•--•-------•-----•--•----------------- <br /> ----- ----------------_------ -------- -------------------------------- ---------------_---_------I-------------------------------------­---- <br /> ------------------------------------------------------------------- . ------------------- ----------------------••------- <br /> - ------------- ----------- . . -----• . . --- ---- ------------ ----------- ----------•------------- -------------------_1 <br /> --•-•-•-----•-----•--------------••--------------- ------ <br /> FINAL INSPECTION BY:. -.1--)- - = <br /> �! � <br /> ate_... - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />