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FOR OFFICE USE: <br />-------------- APPLICATION FOR SANITATION PERMIT Permit No. .ra2. -- ' <br /> ---------------------­._.--------- (Complete-in Duplicate) 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. w—AAI, - Z-- F- N ;r <br /> JOB ADDRESS AND LOCATION-- 71/ LCA__ <br /> -------------------------------------------------------- <br /> Owner's Name - .... 1.11l � ... Phoned <br /> +'tN 4, ------------------------------ -------------------------------------- <br /> Address--7ll.---#--------W_-c�--��-------IX-4 '-----r -- - (S 6 <br /> .. !. '?---- ---�""e- ---------------- Phone - ---- <br /> Contractor's / <br /> Name---- --------- ---- -- ------------------------ <br /> Installation will serve: Residence [g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I <br /> Number of living units: __ _._ Number of bedrooms __2___ Number of baths.---/---- Lot size ----- --- -------- -------- -------.------.---._-_-.._.-_-_ Y <br /> Water Supply: Public system ❑ Community--system ❑ Private [9 Depth to Water Table ------ _ it <br /> Character of soil to a depth of 3 feet- Sand I5 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date---------- ...... ) No ® New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No I*, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: /?eft <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n <br /> "� �� Material,----±n01�/Fli-e �------------- I <br /> Septic Tank: Distance from nearest wek__.S _-_.-Distance from foundation--.- ..__ <br /> ® No, of compartments - --f_-------------Size_'-_, 10'---Liquid depth---6-67.--- . Capacity-l'.2-0-0------ <br /> 'T to nearest lot line----- .�---_. <br /> Disposal Field: Distance from nearest well... Q-_---Distance from foundation_------------- <br /> Nu <br /> .-- <br /> Number of lines---------Z----------------- Length of each line--.------ �_.�--------Width of trench....-__-- ---------- <br /> Type of filter material__��s-------Dep ---------- <br /> th of filter material....:1..97_...._____.-Total length------ �®-T--------------------- <br /> Seepage Pit: Distance to nearest well..--------------------Distance from foundation-------------------.Distance to nearest lot line----------------- <br /> Number of pits-- --------- -------Lining material------------ -------- Size: Diameter-;-------- --- Depth---------- --------------- ------ <br /> El <br /> Cesspool: Distance from nearest well ----------------Distance from foundation._...... _...... ..Lining material------------------------------------- <br /> I' Size: Diameter- ---- -Depth--------- -------- .--------------- -------------Liquid Capacity,,,----, ----------------_--gals. <br /> F Privy: Distance from nearest welf------_------------------------------------------ Distance from nearest building------------------------------..---....... <br /> ❑ Distance to nearest lot line --------------- ------ <br /> Remodeling and/or repairing [describe------------------ <br /> r: _-- '------------------------------ - <br /> ------------ <br /> --_- ----------------------------------- <br /> ------------ ------------------------ <br /> --------------------------- <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 and regulations of the San Joaquin Local Health District. f <br /> r --------- - ------------•------ --- <br /> (Signed, --------- ...(Owner and/or Contractor) <br /> t -------------------------------- ----- -- --------------- -(Title)----- - -------------- ...... ------- <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 B ------------------------------------- --- ------ DATE._._A?.'/.741--------------------- --------- <br /> REVIEWEDBY ---------------- DATE-------- -------------------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- -- -------------------- --------- DATE <br /> Alterations and/or recommendations-------------- --------:------- ------------ ----------------:--------------•---------------•- ------- -------------------------_------------•-------------- <br /> ------------- - --------- ---- <br /> ------ -------------------- --------------------------------------- ------ <br /> ----- ----------------- --••----- --- <br /> I <br /> Date.............. _�7 <br /> FINAL INSPECTION B - --------- - ---- <br /> 1 I <br /> JS/AN AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton, California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />