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17 <br /> , FOROFFICE USE: � <br /> ✓ n, <br />---.-_----/ �!/'�rf-_:. ._ APPLICATION FOR SANITATION PERMIT,. }, Permit No. <br />----------------------------- ------ ------------------ ( T mp ete in"a?uplicate) 4 � <br /> Co I _ # # Date•issued,.-:::J <br /> .._ :. <br /> This-P•etmiFExpifes-i`Yemar FroDate Issued' €"`"� { <br /> Application is hereby made to the San Joaquin Local Heal}h District for a per #.to construct and i stall the work herein described. <br /> This application is made in compliance with, County Ordinance No. 549. <br /> JOB ADDRESS AND L ATION..�, _._/# %,C'Q p... � "� �� v__ .................................. `} - - - _ <br /> --•• ----•--..__ Phone---•--...................... <br /> --�k.......... <br /> 1 <br /> Owner's Name----------- �- "-`•--1-•---.- I-�_LL 1S_--- <br /> AddressL ,_�.!� -------------------------------------------------------------------•------------ <br /> Contractor's Name....... .1 --•---•--��szC? T_� ------------------------------------------------------•-----.-__-.__ Phone................................... <br /> I <br /> Installation will serviP—Residence'�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ) <br /> Number of living units: -__-__ Number of bedrooms ___:7Number of baths .)----- Lot size .../!5tq---xl ...............:I...'_.__ <br /> Water Supply: Public system Community system [IPrivate F1 Depth to Water Table -------- ft. <br /> Character ofiseil to a.depth of 3 feet:' Sand.❑ _Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0.,�lard�an.❑ <br /> Previous PP; - ( y [�r k ti i _ on: Yes ❑ No �HA/VA: Yes ❑ No G]� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-=) No New Construct i <br /> 3 <br /> (No septic tank or cesspool permitted if public.sewer is available withint`200 feet.) <br /> Septic Tank: Distance from nearest well--! ---_Distance from foundation. -__ aterial---- <br /> . c ........;-of-compartments_____ .__l : Liquid depf �. _� Capecity....s.aA <br /> �F v� � tion____/�__ ------Distance to nearest lot line.___.���_.�__: <br /> J <br /> 1 <br /> Disposal field: Number of lines.. <br /> eli__'_ --_= 1 Length of reach I ne __ ...-•_____________.Width-of trench._._ __ �.__.s_____- <br /> > r j � <br /> :x ------ <br /> Type of filter material- of filter length........ ........ <br /> w �I � <br /> Seepag Pit: Distance to nearest well-------- _15isfance from foundation--- _Q_�. ,.Distar;�e to 'nearest lot line.-S. <br /> Number of pits....]...............Lining mate ria l--X'ks-JL:�____.__.Size: Diameter_�..,�_-�___.____.___,Depth._rr�S!__._�---______- <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 _i' <br /> 0 Distance to nearest lot line---------------------------------------------------- ------------------------------------------------------------------------------j---=------ <br /> i 4 <br /> Remodeling and/or repairing (describe)=------------- 77 -------- ----- • . ---........ ....... .... . ` <br /> f, .......-----•--•-----. fx , <br /> ,, ..� ES �•,--- <br /> -------------------------------------------------------•= --------------------------•-••---•------•------•------•--------: =-_--•-----------------_---------••-•--•--••---•----•------------.---•.----------.-••�- <br /> i z . t!; <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)........................... --�;--- �'`��--...------------------------------------------------=---------------------------(Owner and/or Confreetor) <br /> t I <br /> ,�1 ` <br /> ----- <br /> By:-------------------------- ---�� ------1.�.►---V-1`�_e----------------------------------------------- {rtle) -4 -r-i-��------ --------- <br /> (Plot <br /> - -----(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> A FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE I �- (� r - <br /> -- --------------------------- <br /> REVIEWED BY DATE.... <br /> --------------•---------•- <br /> BUILDINGPERMIT ISSUED----- --------------------------------....----------------------------------------------------------- DATE-------------------------------------------------- ------- <br /> Alterations and/or recomm nSP'atlons: --------------- -------------- --....._..... - <br /> R_. <br /> --•- <br /> f � .�. - :7�. -------------- ------ <br /> r <br /> --•---•.-•-•---------------------------------•---- ......--..._.- - ---------- -------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------- ------I•------------------------------------- ------------------------- --­ -------------------------- <br /> FINAL1NSPECTIGN_..BY: �s_�.. . _7 _ �--�•-s.,�—� <br /> 1 ` <br /> SAN JOAQUIN. LOCAL HEALTH rDISTRICT. y F <br /> 130 South American Street 300 West Oak Streel;';='': 134 Sycemon Street 305 West 9th StreetVj <br /> J • 1-,. <br /> Stockton,California Lodi,California Manteca,Callfornia Tracy,California <br /> ES 9 REVISED B-59 2M 21-61 AYLAB <br />