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-�/ r R urrit—c VJC: <br /> I Ass,-- ---�- Z ---- ------------------------- 17 <br /> -- �l1'PLICATION FOR SANITATION PEtZ10AtT Permit No. ..1. <br /> (Complete in Duplicate) <br /> -. This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo k herein descr'bed. <br /> This application is made in compliance with County Ordinance No. 549./ 3 I/ij-/ �. <br /> JOB ADDRESS AND LOCATION - - -" '�"J ------------- <br /> - / - <br /> Owner's Name----.............. <br /> .....-........ ........ PhonelCl.:4-3---%•-f---Z <br /> Address......... ..yv.. ..- SKF•-------. . .... - - — .._...__...—....-...............................-.... <br /> _.. <br /> Contractor's Name.--------- - . ............-----------------------....--•--_....................... Phone...........---^...-•—......... <br /> Installation will serve: Residence (,). artment House ❑ Commercial ❑ Trailer Court ❑ Mo_tel ❑� ®Other ❑ <br /> Number of living units: ..--.... Number of bedrooms _Z Number of baths /..... Lot size .-.-ll ! Vic...-,--_--..-_--_.._- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth To Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> ses Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> V Sep is Tank: Distance from nearest well--_4.-_0..Distance from foundation....& ._.MaterrIl----------4— :.... <br /> No. of compartments...---.----- �L- .._Size--..- .-..-----_..Liquid depth_...3-----------------Capacify.1a'12.{�... <br /> Disp al Field: Distance from nearest well... v...-.Distance from foundation...- ..-...Distance to nearest lot line........_._._ <br /> ` Number of lines............ >----.--... . Length of each line-.--.-- -0.�� ....Width of trench..._ -�..............._..... h <br /> Type of filter materia . -. .. _... Depth of filter material....,/..--.....Total length..........d-e......----------_ <br /> Seepage Pit: Distance to nearest w --Distance from foundation-.-..._..-----Distance to nearest lot line---------------C <br /> ❑ Number of pits......................Lining material............-----------Size: Diameter....--_--_---------.Dept h-----_---........_._........ <br /> Cesspool: Distance from nearest well.................Distance from foundation.-..-.-----...--_-Lining material.......................... <br /> _.-.- � <br /> ❑ Size: Diameter.----------------------.............Depth----------------------------------------------- Liquid Capacity......—-------_---gals. t. <br /> k. Privy: Distance from nearest well.................................................Distance from nearest building._-_--_.----------..._._---.0f <br /> ❑ Distance to nearest lot line------.................. -'---------------------------•-------'•-----------------------------------••------- <br /> LRemodeling and/or repairing (describe(:...........................-...............------_------------ `- —_....._... — - _-- --_ 9 <br /> ------ ----------------------------------•----•----------------------•-_•-•----•---------------••-------r--•----... <br /> .....—_.._..----••------------------- <br /> L -- - - ------------------------------------------------------------------------------ . P <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 and regulations of the San Joaquin Local Health District. -16 <br /> (Signed)---................................................---------------------------------_.......----'--'----------.. ...... ---------------(Owner and/or Contractor) W <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side) <br /> ... FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--.................. - --t---------------•---._.....-- -.. DATE-------_-Q .1 _6-- '--- <br /> LREVIEWED BY------------------- ..................... _- —.- DATE------....... ----.... ------------................ <br /> BUILDING PERMIT ISSUED - --...- _ - --------...------......--- ......------... DiNTE - .... -- ----..............— - <br /> Alterations and/or recommendations:....................__...............................----------._...------•---------•-•------...-------------------.....-- -- <br /> - - -........................ ...............................................-----------•---------------------••--_..--------•..-......._..•.....-..••----.....-----..•-•--—- <br /> b ....................................................-.................................----...........................-...................-................-............. ............--............------------- <br /> Llr: <br /> P <br /> FINAL INSPECTION BY:----------- -- ._ .._................... Date_- - ........ 1 - ....................----- <br /> L SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soath American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strut <br /> Stockton,California Lodl,Celifernio Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5.62 ATLAS <br />