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FOROFFICE YSE: ­7L <br /> = » ! T 9 .y <br /> -------------------------------------• APPLICATION FOR SANITATIONPermit <br /> PERMIT No. 43__....[.... <br /> --------------------------------------------------------- (Complete in Duplicate) <br />-------- -------------------- I This Permit Ex fres 1 Year From Date Issued Date Issued ....... ....l.lul <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 AND LOCATION---•--__71+5---W,__Bovard...St-...,ftnckton <br /> Owner's Name------Phi11ip5..C'S1Cili^]LC�'ia Qil__,�r.lJ. <br /> ------------•-------------------• Phone.•HO•_.2,Q71.5-----•--- <br /> Address...................N1--_W*.-•Soh,..- • <br /> Contractor's Neme----The...DAY...a..N.IGM-.-S-ept.ic__-T.a,itk__3e r.vita-------------------•--------------. Phone--- 0...63&j--------- <br /> Installation will serve: Residence W( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___3,.. Number of bedrooms ---2_ Number of baths _1___ Lot size _.._.._.. 0.7.�-__X.-.5Q4........---•-•-----,-• <br /> Water Supply: Public system XX Community system ❑ Private ❑ Depth to Water Table __40t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelm Hardpan ❑ ` <br /> Previous Application Made: (If yes,date---------------------) Nom New Construction: Yes 5t(No [a FHA/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 /> SAptic Tank: Distance from nearest well_NUYJIe__..Distance from foundation-----1.Q1......Material_...__GQ...BxIck......::........... <br /> �X No. of compartments--------2----------------Size..5611x46!!--------...Liquid depth......5_811--------- Capacity-....8-0-0 <br /> ._ ._-GaiS. <br /> Disposal Field: Distance from nearest weli__N1Qrie-.._.Dist Distance i '6Porn Pouunedation.....3,-Q!------Distance to nearest lot line.......�1..... <br /> EXX Number of lines.....3----------------------------Length of each_line-------9Q-t----------------Width of trench-------24f1- k <br /> ----------•--••-•- <br /> Type of filter materiaL&ept_,_.--Rk_Depth of filter''material------1$"---------Total length-------._..-9_)1---------------------- <br /> Seepage Pit: Distance to nearest well---N_QXI<r-------Distance from foundation__...2W._-__ <br /> Distance to nearest lot lin Z5.1------- <br /> 12X Number of pits......I------------Lining materiaRack-----------Size: Diameter_.._.__33 ........Depth------..2.5--------•--------- �y <br /> Cesspool: Distance from nearest well--------------- <br /> -.Distance from foundation--------------.____.Lining material........................... <br /> _......_ 1 <br /> Size: Diameter------------•-------------------------Depth------------- ------- ------Liquid Capacity gals. <br /> Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building <br /> ❑ Distance to.nearest lot line <br /> Remodeling and/or repairing (describe):_____________________________ <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. <br /> [Signed)--The--DAY & NIG U Se-Laic---Tank Ser _±Ye_____--_--- <br /> (1hM3[0*W Contractor) <br /> By:...............------------------------------------------------------------•-- rfie)------------------ ---- <br /> If <br /> (Plot plan. showing size of lot, location of system in relation t ells, buildings, tc., can be placed on reverse side). <br /> 42 FOR DEPARTMENT USE ONLY € <br /> APPLICATION ACCEPTED BY------ ---- ------------ ----------------------- --------- -------------------. DATE---------1--' <br /> REVIEWEDBY------------------------------------------------------ --------------------------------------------------------. DATE <br /> BUILDING PERMIT ISSUED--------------------------------------------------- -------------------------------------- DATE <br /> Alterations and/or recommend'tions:_______._____..__._ <br /> -----------•----------------------------------------------------------- --------------------•------------ I <br /> FINAL INSPECTION BY:._ ...........................--- Date_...______ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak sirsit 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California v Manteca,California Tracy,California <br /> EB 9 REVISED B•B9 2M 5-61 ATLAS <br />