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FOR OFFICEUSE: <br /> Z/ <br /> ---- -------------_-_.__-----____.__.---. ------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----- -------------------------------- ---------------- (Complete in Duplicatel <br /> -------------------------------- I This Permit Expires i Year From Date Issued Date Issued ---- <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 <br /> compliance ith County Ordinance No. 549. O'1�0- d <br /> .2;) �5 <br /> JOB ADDRESS"ANDLOCATIO ----- c[, <br /> L <br /> VY-- t3F- pTf _�7, � <br /> Owner's Name l�I}Z ----------- _ - ------------- ---- Phone--- <br /> hone- - <br /> - ------------------------- ----- - <br /> Address -- <br /> R T ----- --------------------------------- --------------------------- <br /> Contractor's Name �lLd-_lE } = ------ ----- -----------­ ---------.-. Phone----------------------------------- <br /> -------- '------------_--------- <br /> Installation will serve: Residence Apartment House ❑ Commarciel ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: -----I--- Number of bedrooms _ I __ <br /> ._ Number of baths -j-_-- Lot size -------/3/ <br /> Supply: Public system ❑ Community system ❑ Private Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Q'-Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes EY]- Jo ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> "` (Nd septic tank or cesspool permitted if public sewer is available within 200 feet.) _ .- <br /> Septic Tank: Distance from nearest welf_S-C7_.---Distance from foundation__ Q----.._____.Mteri I___-_ 011fC <br /> ------------------- <br /> No. of compartments------- - ------Size--7--X�-Q-- - -Liquid depth__-- --_ ��- -------Capacity---LQ_Q,__ <br /> if ` <br /> Disposal Fidlg'- Distance from nearest well -_-__Distance from foundation__-/_0__ ____---Distance to nearest lot line-_ <br /> Number of lines____________ <br /> --------------Length#of each line---;W:7�7-FP,P F _.-.Width of trench--__.____9Y_____.._-__-____ 4� ' <br /> Type of filter material---R-0CK -.__Depth of filter material.._.j� <br /> ----..______Total length---.______- ------------------ O <br /> Seepage a Pit: Distance to nearest well---------------------Distant.)fr m foundation-----------_......_.Distance to nearest lot line--.__.___..___ � <br /> Number of pits----------------------Lining materia l__-----___._ `_`.Size: Diameter------------------- ---Depth-------------------- - <br /> .4 ilj <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---..10- ------.Lining.material._,--� -..--.-_-----_------_------ t <br /> ❑ <br /> Size: Diameter-------------------- - ----- ---------Depth---------------------------------------------- --Liquid Capacity----------------------------gals. !�{ <br /> Privy: Distance from nearest well------------------------------t---------- -Distance from nearest building.---------------------------------------- <br /> . <br /> ❑ Distance to nearest lot line--------------_- <br /> ------------ -------------------------------------------------------- <br /> - -------------------------------------------------------- <br /> Remodeli and/or repairing (descriire):-_._S T m_____�XCAVAT /x______ 1.4- _ ----TA_Ki l� ---Q[JT--P RS <br /> t - -; --- ---------- -----------------------------------------------------------•------ - --- <br /> TtR.,© i. <br /> ---------------- . <br /> --------------------- ------ -------- ------- ---- ----------- <br /> , � � . q County 'i <br /> I hereby, certify th °ha a prepar d this application and that the work will be done in accordance with San Joaquin Coun ° <br /> ordinanc s, tate fa nd ru sand eguiations of the San Joaquin'Local Health District- ---*--a <br /> Sind <br /> Il <br /> { 9 )---- ---- --- --- ---------- -� - ------------------=---------------------_---- ---------------------- -- --------(Owner and/or Contractor) <br /> Y — ---=_------------------- - --------------- <br /> (Title) _..._ - ---------- <br /> (Plot plan, showing size of lot, location of system in relation to wells Lbuildings, etc., carr-be placed on reverse side). <br /> 1 FOR DEPARTMENT-USE ONLY <br /> - r � <br /> APPLICATION:•"ACCEP,TED BYE._[--------------------------------. ~' - ------------------- DATE <br /> REVIEWEDCY ------------------------------------ ............. -------- ---------------------------------------------------------- DATE------ --------------------- ------------------------------ <br /> BUILDING PERMIT ISSUED---------------------------------- ------------------------------------------------------------------- DATE------- <br /> Alterationsand/or recommendations: CoRR��T--f06ta /yam.------PARrt_Ttdn(_----- -- c-- ----------- --------- ------ <br /> --- <br /> s 1 �'M f klr4l KA <br /> ------------------------------------------- ----------------------------------------•------•------------------------------------------------- <br /> ----------------------------- ---------------•---- -------------- <br /> ------- <br /> FINAL INSPECTION <br /> - -- --- ---- - --- --- ------- Date--------------- r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy, California <br /> F.P.C C. <br />