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Zi <br /> ........ ?LICATION FOR SANITATION PERmIT Permit No. ...., .....!.l'.... <br /> ------. . ...._---------------- ---------------- (Complete in Duplicate) Z <br /> Data Issued .-_�__.1... <br /> This Permit Expires 1 Year From Dale Issued I <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 AN LOCATION.- - .----.Lr� . �a <br /> ------------ <br /> - ------ <br /> Owner's Name ) ►..". ly --- Phone8„�1-` �i..Zf <br /> Address.................. <br /> --- <br /> -_-----4--------- --------------- -------,-�----/------------------_------------- -. _-_ .-- ------- <br /> Contractor's Name----------------- �.. .J----- i --------------------------------- Phon '�' <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 2 1davi. " <br /> Number of living units: --- ---- Number of bedrooms -------- Number of baths -------- Lot size t <br /> Water Supply: Public system �ommunity system ❑ Private ❑ Depth'TO Water Table 6-40- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B---Hardpan ❑ <br /> Previous Application Made: (If yes,date................... ) No ❑ New Construction: Yes ❑ No k-.**`FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest ` 11)��-C.-Distance from foun/datipn_-�D--------- Material / -------- -------•_-___-_---•--------. <br /> No. of compartments... - .. .......... zs�.X_ .xjw-_Liquid depth___. .. __---_ p y___'_-yid__-• ,CL <br /> ©�. ._.. _Siz _._.__Ca aut � <br /> Disposal ield: Distance from nearest we11­�,�_Distance from foundation_, .. . _ Distance to nearest lot line. <br /> Number of lines--------- . . -.-.-Length of each lin - D <br /> - - - - 9 e��_...3.5�=:�5.�.--..Width of trench.-.._,2. - <br /> Type of filter material.-. -.e- . /��: .-Depth of filter material..._ _ ....Total length___.---.-A-d__"------------------ <br /> Seepa it: Distance to nearest well_ Distanc om foundation..37--------------. �S UA <br /> - - -- -.- � Distance to nearest lot line................. <br /> Iq Number of pits...-- / _---..-.___-Lining material_%. -QC <br /> t/ �---...Size: Diameter . �I. -- ----Depth_ -•C-, -•----_---------- <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---------------- ------------------.------ E <br /> ❑ Distance to nearest lot line------------------_-- <br /> -- - - <br /> dRemoddellig and/or repairing (describe):-. .� i?jj,...�i <br /> - ' <br /> ---------------- <br /> Ll <br /> -- ------ - <br /> -------------- <br /> --------- ---- <br /> I he certify t at I have prepared this application and that the work will be done in accordance with San Joaquin County Q <br /> ordinances, State laws, and rles an regulans of the San Joaquin Local Health District. <br /> (Signed)--- � ------ --- .. . - -,------ -- - ---- ------ ner and/or Contractor) <br /> BY:............................. i �,�Ie. V�/-- . . itis).. (- <br /> (Plot plan, showing size of lot, location of system to rel tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY............................. ------------- ---- -- - -- _L -..�, DATE------- I. ----------. -- <br /> ....... <br /> REVIEWEDBY ------ -------------- DATE_--------------------------------------------------.- <br /> BUILDING PERMIT ISSUED-------- ---------------------- DATE.------ ----------------------- <br /> ` Alterations and/or reco mendration;:_-..._..._. ............ __ __- /f <br /> _ <br /> 1 �- --- <br /> y. <br /> 2------ <br /> ........................................................................................_.._........__..._._.._..................._........-------......--..._....-_-_.'-----------...........-........-- <br /> z Gni:-�_� Date..............................���` <br /> FINAL INSPECTION BY:f'C ..... .. ...................................... ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Weft Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8159 2M 5-62 ATLAS <br />