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FOR OFFICE USE: _ _Y <br /> .................--- - -- ------- ----------------- ------- <br /> ----------­------------ <br /> ------------------------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - -------------------- ------------ ----------------- (Cornplete•in Duplicate) <br /> '- -'_ --- -- Date Issued- T-= `6- <br /> "Tftiis Permit Ex ares 1-Year From-Date"!"ssul3rd -- - <br /> Application is h&e6y 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 /> ; <br /> JOB ADDRESS AND LOCATION----- .�_R4_TH_ROF�* <br /> ------ <br /> Owner's Name_ �LT')r © - ---- --- ------ <br /> ------ Phone-,---------------------------------- <br /> Address----------------- � I <br /> ------ - l-lzzQ.-------•--•------------ -- -------- /g i <br /> Contractor's Name �_1Nnl.l _ ---------- --------- -------- -------- ------ --------1------- Phone---------------_----------------- <br /> p ❑Commercial ❑ Trailer Court ❑ j Motel ❑ Other ❑ <br /> Installation will serve: Residence Apartment House , <br /> Number of livingunits: _ Number of bedrooms _ -„Number-of baths-J---- Lot size ------ f 5000 LZ -^}—................ <br /> Water Supply: Public system ❑ Community system ❑ Private i Depth to Water Table . _ ft <br /> Character of soil to a depth of 3 feet- Sand Gravel El Sand Loam Clay Loam 0 Cla Adobe El Hardpan Cl <br /> Previous Application.Ma.de: (If yes,date................__ ] No New Construction: Yes ❑ NogFHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ <br /> 4”"�`"� (No septic tank or cesspool p re miffed if public sewer is available within 200 feet.} �I <br /> ' K <br /> Septic Tank: Distance from nearest welL._�d-___Distance from foundation__IO____-_--.ffistance <br /> • �.�11��T�_ <br /> RE�gAG� No. of compartents_-------�_---- -.-.Size_ _x --Liquid depth--- --------Capacity--: DO <br /> Disposal Field: Distance from nearest well ____________Distance from found•aiion:tt=._________.._. to nearest lot line______________... <br /> I <br /> ❑ Number of lines.---------------- -fir----_------Length .of each line_- -----�------------------.Width of trench----------------------------------- <br /> Type of filter material---`-------_-.-- Depth f filter m ter- ----------------------Total length--.-------------_---;---------------••_-.- <br /> Seepage Pit: Distance to nearest well-------..____. vf!n7Distance from foundation__________________ Distance to nearest lot line_.._._.____-_.._ <br /> Number of <br /> Cesspool: D stance fromtsnearest well ^ ^A` 1 Size: `Diameter---------__. ___-___-Dept h_...__---------------------_--_ ` <br /> ------------------Lining material__ I <br /> I I I � C <br /> P from foundation_____________ __Lining material--.__._____...____--__-___-______--- <br /> ❑ Size: Diameter- -1 --+------ ---- _ --Det -------- ----------_--- �------`-------- -----.Liquid <br /> I I � s t q d Capacity. -------gals. <br /> Privy: Distance from nearest well_ __....__` -rr :, p s e ' from building_______---------------------------------- <br /> ❑ Distance to nearest- lot line ------- - ----------------- -------------------------------- ------------------------------------ --------------- <br /> Remodeling and/or repairing (descriUeJ:----':C:--- �_.... p[ �} .__._F TF_= <br /> 5 'HA — ---------- = ¢. 1 <br /> 4. --------- - <br /> --------•---------------------------------- t 1 <br /> I hereby certify that i have prepared! his Iication,and th } <br /> --------------------------------------------------------------. I I <br /> y - r Pp -------------------- <br /> A -------•------------------------- -------------------------------- -------------------- <br /> at the work will be done in accordance with San Joaquin County I <br /> ordinances, State laws, and rules and re ula}ions of the San Joaquin Local Health District, <br /> (Signed)------=I-I'll�.�_A... ` :,' <br /> --��— ... 4-.-- . _ __,r p .�, _--;(Owner and/or Contractor} <br /> ------ yr <br /> BY f - (Title)---------I - ..........._ ................ --------- } <br /> (Plot plan, showing size of lot, locaN o f system in relation to wells, buildings, etc., can 6e,placed'on reverse side). <br /> -`� FOR DEPARTMENT USE ONLY i <br /> .4 <br /> APPLICATION ACCEPTED BY_ - �- ---�----'---- <br /> - ---- DATE_----f- <br /> - <br /> REVIEWED ----- -------------------------- <br /> BUILDING <br /> ------------------------- <br /> BUILDlNG PERMIT _ - ------------------------- -- ------------------------------ ATE <br /> ----- ------ ---- ------------------------------------- <br /> E--------------------------------------- ------------ DATE- i <br /> Alterations and/or recommendations:----------- -------------- .... <br /> ---- <br /> - _ - <br /> ...............-• ....---------- • .......... -.- -.—, _ :_'.- ----------------------- ------ ---------- --------w.------- --------------------- ----- -- <br /> ------------------ --------------------------------- -- ----- ---------------- <br /> —------------------------ <br /> — <br /> FINAL fNSP N BY:- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi. California Mante a,,California Tracy,California <br /> E,H.92M 1.67 Vanguard Press <br />