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!` FOR OFFICE'USE': W <br /> ---------­___;;,C:----------------------------------- - r•� �� 7 <br /> APPLICATION 'FOIZ SANITATION PERMIT Permit No.. . .......... ........- <br /> -- ---------------------------------------------- (Complete in Duplicate) Date Issued <br /> � <br /> 3 ,� _:_2"Z,.-_�-:--.,�-r�4-.ertw_:�___�.__. This Permit Expires 1 Year From Date Issued <br /> , t . <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. 2`{^7—2rtfO —� c� C.141_04 <br /> s4a� ss.� <br /> Its <br /> R �" -Flr-- <br /> JOB ADDRESS AND LOCATION - ----------- <br /> Owner's ='r` : <br /> Name ll.1C_-�mket.J -`-------f -wL�-------------------...---------------------- --------- ------ Phone <br /> p� <br /> Address-----••------- ------------ <br /> R T�_-------�------------f_,�f�.X Thr s� _L. :------------•--•--------------------- <br /> Contractor's Name--------- ha. ------------------------------------------ --------------- ------------------------------------------•---- Phone......--------------...------------ <br /> Installation will serve: Residence [Apartment House E] Commercial ❑ Trailer Court E] Motel El Other L) <br /> I f <br /> Number of living units: -!".---_ Number of bedrooms __ - Number of baths __ .-__ Lot size ____.__ --------------- <br /> Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table 3.6 f. st <br /> Character of soil to a depth of 3 feet: Sand Fr Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ -'Adobe❑ Hardpan ❑ <br /> ' Previous Application Made: (If yes,date--------------------I No New Construction: Yes E] No �'t Hi4yVA: Yes ElNo [ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , 1, <br /> �,,...(No septic-.-tank or cesspool permitted if public-sewer-is-available-within 200 feet.) <br /> —._. <br /> Septic Tank: Distance from nearest well------_---------:Distance from foundation__.____-____..-__-_Materialx_-_____.._________-____________. <br /> " r�c— No: of compartments-------------- ------Size--=-°'-------- --- --- - '=_LEquEd depth P CapacityUJ <br /> Disposal Field: Distance from nearest well....- ; __._...Distance from foundation-------------- _....Distance to nearest lot lin —__-_._______- <br /> F—)(ff>T)N r Number of lines___________ _ _-----------------Length of•each,line____:_ ° -_( -----Width of trench___-__ __.___ -- ---------- <br /> AV V <br /> __.___.AVV Type of filter mate rial__,R.Q_C)<---Depth of filter material_.__ �__-------Total length--------------7s----------------_ o <br /> P g I ________________Distance from foundation--------------_------Distance to nearest lot line <br /> _.__.__-___.__... <br /> Number of :ts.__.-----•--------- <br /> See❑a a Pit: D stance to Dearest wel -- Lining mateial_-__-----------------Size: Diameter__•`_"`-:.__..___-_ Depth___.__._-________________.____.- <br /> s -- ----------Di th •-- fo i t ------------ Liquid mate ty �-------------gals <br /> Cesspool: Distance from nearest well__________._.__Distance from foundation___...___._.._...-linin material_____________________________________J� _ <br /> Size. Diameter---- - - P <br /> ❑ I <br /> Privy: Distance from nearest well_ .;,,,_____.-_____. k___-------------- - - Distance from nearest building.----.-__._____--____-_____.__-----_-.Distance to nearest lot line--- - ------------ -------------------- --------------_--- ---------------------- ------------------ -------------------- -- <br /> Remodeling and/or repairing (describe --- ---------------- <br /> -------------------------------------------------------------- ---------- = --------------------- - f <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, Stat laws, and rules and regulations of the San Joaquin Local Health District. <br /> IS .�: <br /> I (S, ned} ----------------------- -------- ---------- ------•----------- - -----(Owner and/or Contractor) <br /> t # (Title)------------- - ------ -------------- - ------ --------- <br /> w - Br --- -----:r Y; ;----::;;::-:— --------------------------------------------------------- - - <br /> (Plot plan, showing size of lac, location of system in relation to wells, kiuilaings, a#c.,can be placed on reverse" <br /> r <br /> f <br /> .�«� =•� .;. -�FOR DEPARTMENT USE ONLY <br /> r APPLICATION ACCEPTED BY. r ---------- DATE---------- ---�_ <br /> ----------------- <br /> A ' <br /> REVIEWEDBY-------------------------------- _-A-1-------------------------------- ------ -------------------------------------- DATE--------------------- --------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------'`_-------------- ------------------;------------------------------------------------------------------- DATE---------------------------------------------------•--------- <br /> Alterations and/or recomme dations:._:---------------------------- -- ----------------------- - <br /> ----- ------------- -------- -- <br /> zo ` _.no©. -PJRo.6-�"s--------------5—j—1O <br /> ----------------Ip-------- --- - -- �` <br /> inrA RO8-1—L=&I-------IS--------41319.1 ,P__-:------. 4-1 5 1 <br /> ycvA.--------- '�z- -------�U --------No---------I1y-si>h_c ar w�.� �'�'L-�-� -----------�� <br /> 5 - ....../ _T`l?. U..rfl.�t` <br /> FINAL INSPECTION BY:...__rr__. __ -0' ------------ ---------------- Date------------- _.4.. `_V-e,5 --r <br /> .---- ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> etis. <br /> E w <br />