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rUKUl-HCE USE: <br /> - <br /> • ----------- ----- --------------------------------____- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ��--- (Complete in Duplicated <br /> --------------------------------------------------- - <br /> --- This Permit Ex Expires 1 Year From Date Issued Date issued 1 -_ -�� <br /> Application is hereby made.to the San Joaquin Local Health District for a permit fo construct and the work herein described, <br /> f— <br /> This—application is made_inrcom iannce with County Ordinance No, 549. <br /> ' <br /> JOB ADDRESS AND LOCATIO -_-- T-I- ®� 1�� X.0 , �` <br /> c > �---------------- <br /> Owner's Name-------------- .?-J �_ i A _M_ _' cU <br /> P 'L-- . <br /> Address ---- <br /> ------------------------ <br /> Phone-- ----------------•-------------- <br /> -70 <br /> l <br /> ' �h - ----------_111---------------------Contractor's Name___----�ARC�1��__-------------------- ------------------------- <br /> Phone <br /> Installation will; serve: Residence ❑ Apartment Nouse ❑ Commercial Trailer ❑ <br /> 1; <br /> 'Court ❑ Motel ❑ Other <br /> Number of living units: _.__ Number of bedrooms _"e- Number of baths __I__- �t size <br /> { id 1"aC <br /> ------------ <br /> Wafer Supply: Publicl-systemh—am sys em ❑ Private Depth to Water Table /0- ft. <br /> Character of soil to a depth of 3 feet: Sand 2Grav l ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> ❑ <br /> Previous Application Made: !,[eyes,date____________________) .No New Construction: Yes �o ElFHA/VA: Yes F] No � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> `­{ p spool permitted if public sewer is available within 200 Iff" <br /> 1 <br /> ___ __,Distance from foundation-1[ <br /> Septic Ta k: Distance i - <br /> p o se tc tan br cesfrom nearest well__ -J-�_� e �� <br /> ti � <br /> M.a"teriaL_CO/VCR_ <br /> No. of compartments------- -----------i Size _)C-9_k-- --U u ''depth A Capacity _�� <br /> i { . <br /> p from nearest well. dA.Dls an pf from <br /> f uncia{ion_ �a 'Distance to nearest lot I'ne f- 1 <br /> Dis ossa=Field: Numberof lines_________ - <br /> � pp <br /> �, 9 -- int-----..Width}of trench <br /> Type of filter material._�' GX.._Depth of filter material-.___1 __-----_ <br /> !i � -Tota! 'length--------------------��--'------- <br /> Seepage Pit: Distance to nearest well----- .___ 3 <br /> :Distance from foundain ._: bista_nce,Ctoyn_earest lot line----------------- <br /> El �f Pits._.._ ---- ------Lining material----- --------------Size Qlameter---- --- -----Depth -------- ----------------------- <br /> Cesspool: <br /> um er f om nearest well �1 Distance from foundation. __---------------_ 't <br /> Distance Lining material-..-_--._____------------------- i 1 <br /> ❑ Size. Diameter-----------------------------.---_ Depth---- - ,• ----------- -- - - Ciqulcf Capacity gals. <br /> Priv I _$JrA r -1 <br /> Y: Distance from nearest well ..__-__._71__ _ Distance from nearest bulld�ng_I______----------------------- <br /> El 0,lrti•A y <br /> Distance <br /> to nearest lot line----------------------- --- t <br /> Remodeling and/or repairing (describe :____.___--___------------- <br /> ___ _____ ____ _________________4_____LY_'__..__.___-____. __ ____ <br /> __ __ _ _ __ _ _ <br /> ,nu-r?P , A - --- 3i.'ta - 7''+•�� r+�l . QyR 1 <br /> - ------------I-- 0 <br /> y prepared- ---pp--------# ----------------------- --------- i-------------------------------------- <br /> I herebycertify that I have this a lication and that.the work will--------------------------------------------------------- ---------- --- ---------- <br /> o:dinances, State laws, anA�Sand rd"' regulations of the San Joaquin.Local Hf:alheDistriectn accordance with San Joaquin County <br /> - <br /> {Signed) ------------------------------ r and/or Contractor) <br /> -- � - (Owner <br /> BY ------------------------------------------- <br /> c <br /> (�i#IeJ = = _. <br /> 0 or <br /> {Plot plan, showing size of lof;'location"of systemin relation to wells, bgildrng's etc., can beplaced on reversa3tde�:� <br /> -....- <br /> FOR DEPARTMENT USErONLY <br /> APPLICATION ACCEPTED BY_ _- `f-R.d- __ I <br /> -- ------------------------------------------- <br /> ------------- DATE-----•--��� <br /> REVIEWED BY----------------------------------------- .. <br /> DATE.._. ----- <br /> UILDING PERMIT ISSUED----'.. r <br /> .._ DATE- <br /> Alferations and/or recommendations:__-__.......:....... "" .v _ <br /> l ----------------,I!`t.3 <br /> �ti"4a1 is <br /> ` ; <br /> .- - _ ---------------------------------_----_----------------------_--------------------_------------____._ <br /> ___________________________________---.---------------- <br /> FINAL INSPECTI _. . <br /> Date---------- -/_4% ^_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 3 <br /> !II <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy, California <br /> II <br />