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lxt <br /> APPLICATibN FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued ... OT r <br /> Application is hereby made to +he San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549.12,,R17,01,14 6,0=- d-073 9 , 10116 <br /> JOB ADDRESS AND LOCATION..__.. .............:�� 4 <br /> .......................... .......... <br /> 11A <br /> 1XOwner's Name........ ........ AAm. Phore- 0VK <br /> Address----------------Z4.4 V..ft.......AA7,%&=7Z................................--------------------------------------------------------------------------------------------_---- <br /> Contractor's Name.................... <br /> ...................................................................................... Phone.................................. <br /> Installation will serve: Residence V( Apartment House E] Commercial E] Trailer Court ❑ Motel []. Other ❑ <br /> Nurnber of living units: ./...._ Number of bedroomsNumber f baths ........ Lot size <br /> Water Supply: Public system E] Community system [] Priv� 2Depth to Water Table - ft. <br /> Character of A to a depth of 3 feet: Sand E] Gravel [] Sandy Loam E3 Cli Loam E] Clay E] Adobe ZHardpan C3 <br /> Previous Application Made: Yes E] No gr' Now Construction- Yes D No 7 FHA/VA: Yes F] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septicirl8nk: Distance from nearest well._ZkO.......Distance from foundation...A0..........Material_A�.Ao&.0_0- ------------- <br /> No. of compartmenfs............S-*,O.o.........S i z a ........Liquid depth....---11---------------Capacity....ym-4. 4 <br /> s <br /> Disposal Field: Distance from nearest well....%I.;T......Distance from foundation...A..,.__....Distance to nearest lot lin <br /> NI <br /> umber of lines-------------I. ..........Length of each of trench... <br /> Type of filter material....;42 Depth of filter rnaterial.._Z�*.........Total length......... ............... <br /> Seepage Pit: Distance to nearest well......:........._.-Distance from foundation....... -__Distance to nearest f6t"line........... <br /> ❑ Number of pits......................Lining material.....................-Size: Diameter........................Depth---------_-----=1=.......... <br /> Cesspool: Distance from nearest well.................Distance from jounclation....................Lining material.......-........._.-..._._....._.... <br /> El Size; Diameter.-..................................Depth........................................_.._...Liquid Capacity............................gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building......--............_..._._...._....._... <br /> ❑ Distance to nearest lot line-_.._................................•--•----•--..._---•----•----...............------..._.......--...................................... 'Ilk <br /> Remodeling and/or repairing ..Aw. ...... <br /> . I 0-A-V-------------------------------------- <br /> a. All _4460"441 <br /> ------- ...... _7t....a_�x4.w--_--_----- <br /> --- - ---------- <br /> ­­---­-------------------------------- ------------­----------*-----... <br /> *--------------------------------------- <br /> ................... <br /> re <br /> her 'y T�certify, that I hav repared this application and that+he 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. <br /> (Sign . (Owner and/or Contra <br /> .....................-............................................ ctor) <br /> (Signed), (a---C.).- ,, <br /> ...........................................I..............................................................................(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 /> . ................................ <br /> APPLICATION ACCEPTED BY......................••.._.......... E............................................................. DATE...---------- AA <br /> --------------------------................................. DATE.... v............................................ . <br /> REVIEWED BY........*----------•---••---••......--...._.. <br /> -------i..........................SUED <br /> BUILDING PERMIT ISSUED........ DATE.... <br /> Alterations and/or recommendations— <br /> -----------._....-•----•-•. •-----•-----•.....-- •--------•-•......-•---• ................. <br /> ........... 40....... ....................... <br /> .......................... <br /> y M-1. 46 <br /> ............................. <br /> FINALfNSP /ION' BY:..---•------------- ......................... ---- Date........................................................................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Straef 300 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton. California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Pavisec 1.57 F.P.00. <br />