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. _. <br /> FOR OFFICE USE: - ti <br /> ---------- ------------ <br /> - --- ----- "---- ------------- <br /> ---------------- --------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> °°- CiDuplicate)-. (Complete n upf ` <br /> - pate Issued ------.�1. <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 4e in corrApliance with County Ordina No. 549.x^ 2­0-7 - ?ftD-Z-g a. �; 5��' <br /> ADDRESS <br /> f /7 Ju l#/ 1 ---�---—2 e?'�' !�•--- I <br /> JOB ADDRESS AlA D L CA ]ON-_� ✓ --- ------ - - - - -- ------ - - -------- ------- - ---------------� ---�y-r-�-------- -------- <br /> Owner's Name----------- -_----. <br /> ----------------_---- <br /> � /f'�?. -------------- ----------------------------------------------- <br /> Address <br /> Contractor's Name---- _J j.�_ 411< -------- --•--- Phone_ ..4,�_�_ICOA9--f7-- <br /> Installation will serve: Residence ©--A--partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/--- Number of bedrooms _-Number of baths rwLof size ----- .'e �------------------ <br /> Water Supply: Public system El Community system E] Private epth to Water Table -4-oft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy,Loam ❑ Clay Loam ❑ Clay [r'Adobe ❑ Hardpan Q' <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes E] No [--1HA/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 /> Septic Tank: Distance from nearest well-----------------Distance from foundation----.--------------Material----------------------------------.-------"----- <br /> ❑ No. of compartments-.-:--- ---- -------------Size------------------------- Liquid depth-------------------- - ---Capacity----------------------- <br /> �*-�� ;0 � <br /> Disposal 1d: Distance from nearest well.. ___ - . Distance from foundation---/�----_----Distance tp nearest lot line-�."--.---- <br /> �-�fi� <br /> Number of lines------'---/--- ---- ----------- ength of each line---- -- --------------Wid#h of tranch...---7-�-- --------- <br /> L ; <br /> Type of filter material--.-S rDepth of filter material...le-_.-.-------Tofa1'Igngth__._- 1 -:--------_-------------- <br /> ,. . . i <br /> Seepage t`""` Distance to nearest wet)-�, �-.-.-----Distance fr foundation---, f.,--_-_.Distance to newest,lot line-��-----.- 0 <br /> Number of pits--------�---------Lining material-- --Size: Diamet'er� .___--_....--Depfh_..1:46------------------ <br /> Cesspool: <br /> --"- -----.Cesspool: Distance from nearest well"--.- ----.-.--Distance from foundation---------------------Lining material'--..... ----- <br /> __------- --------- <br /> E] Size: Diameter------_------- ...� _ Depth------------------------------------ - -------------Liquid Capacity- --------------`'' n--gals. .p <br /> Privy:' Distance from nearest-well---------------------------------- Distance from nearest!building----_--.--r- _------:------------------. <br /> ❑ Distance to nearest1lot line----- ----- ------------------------------------------------------------------------------------- ------- <br /> ------ <br /> .Remodeling-and/or repairing (describe):--------. -- --------7`7V------------ <br /> ---------- x- ---------------------------------------------------------------------------------------------------------- <br /> ------------ - <br /> ,,.. i <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------- ---------------------------=---------- ------------------ <br /> I hereby certify that I have prepared this.application and that the work will be done in accordante�wifh San Joaquin County <br /> ordinances, State laws, s and regulations of the San Joaquin Local Health District. <br /> (Signed _'---- ----------- .-____ 1 j(/- �- '. and/or orContractor) k <br /> --------------------------------- ---- <br /> V BY• --- LTi+ = t'--- - <br /> plan,- showing size of lot, !deet in of system in relation to wells, buildings, etc., can be placed on reverse side:� <br /> FOR DEPARTMENT USE ONLY <br /> - --. �!.'� - - _ <br /> P LICATION ACC,�PTED BY---------�A--R- - -------- ----- ------------------ ------------- - BATE? <br /> i RE�VED BY. -' ------------------------------- ------------ ------------------- <br /> DATE-- - ---- <br /> 1 SUILI NG PERMIT ISSUED-------------------------------------- ---- ---------- ----------------------------------------------- DATE--------------------------------------------------------------- <br /> 4 <br /> ., <br /> Al Mions and/or recommenda+i rys:----------------------•:-------------- --- <br /> ----- T®----V� ------ °4 - Ct ��- ------------------------------------------------ <br /> -------- <br /> ------------------------ <br /> ------------------------------------------- <br /> ------------------- , <br /> _.."-------------------`--------------------'-••-. -_. __.-----------"_---_..-.--____-"----- <br /> j <br /> X .... <br /> r „ <br /> --------------- <br /> • �ti <br /> "; Date <br /> FICsiAL 'I ISP. ;17N-BY:.----- � <br /> ----------- ,: <br /> ` SAN JOAQUIN LOCAL HEALTH DISTRICT,��, <br /> 1601 E.Ha:ellonive. 300 West Oak Street ;f 124 5ycarn Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> � � F.P.0 D. � . <br />