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FOR OFFICE USE: <br /> ---- ----- <br /> APPLICATION FOR SANI <br /> -- TATION PERMIT Permit No. .._. _ .� <br /> ---------------' = (Complete in Duplicate) <br /> -------------------- <br /> This Permit Expires 1 Year From Date Issued Date Issued ..._.._.....�� bl <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. 54y9. <br /> JOB ADDRESS AN OCATION ----7- -J�- ------------ � ' <br /> •............... <br /> Owner's Name----------16_11"_11_7_____ <br /> - - - - ------ Phone..................................... <br /> Address. ., Ql'-f <br /> -----• ---- ---- ----------- --- --- -Contractor's Name.------- -- art __________ -------- • x P=�'� ----------------- --- Phone-----••--•--••---.._:......------ <br /> Installation will serve: Residence Apment House ❑] Commercial E] Trailer Court C] -Motel ❑ Other ❑ <br /> Number of living�units; ...� Number of bedrooms _r2-- Number of baths . ... Lot size � ®- -Q•.�,�_............................... <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table x-e7-_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel (] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe hardpan ❑ <br /> Previous Application Mader (If yes,date--------------------) No U�— New Construction: Yes gj--No ❑ FHA/VA: Yes g?le*No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Septic Tank: Distance from nearest well----_!-�----..Distance from foundation---Z4._----_--..Material--- --G- - <br /> �— No.'of compartments-------Z---------------Size---ss4 `.`X_ �?s Liquid depth----3KZ,_/--------_ ' _•_•.•.-_.,,. <br /> _Capacity-.. fid..--._,. <br /> Disposal Field: Distance from nearest well--- -------Distance from foundation...6; ____.Distance to nearest lot line.4F�l..._... <br /> Number of lines.'- _.._- Length of each lineZ--- 1 idth of trench.. 11,_________________ <br /> Type of filter material r-------- ----- I----.-. otal length.--- <br /> yp (�P[s+�.-_Depth of filter material Total ...................•_--._-_.._ {� <br /> Seepage Pit: dr Distance to nearest well----.-- ------------Distance fWm foundation---/Z........gDistance to nearest lot line..°.-....... y1 <br /> Number of pits----/--------------Lining material...-Size: Diameter--? ------ ------f.._....__---.... 1 <br />' Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--.----_--.-"-___.-__------_-----._ <br /> ❑ Size: Diameter------------ -------------------------Depth.---•---------- ------------------------------------Liquid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest well-----_-_---------------------------------------Distance from nearest building-----•-------------•-___•----•------_----. <br /> El Distance to nearest lot line--------------------------------------------------------- <br /> Remodeling and/or r pairing (descri ) <br /> I :-----=--'I•LG�C�'`_- - -•-----------I--_--­--------------------- ------------------ <br /> -•--------------------•--•--------................•----------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- <br /> --------------- ------- <br /> ------•------------------------------------- <br /> •----------------------------------------------------------- <br /> I hereby certify that I have prep ared•this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules_and.reguletions-of the San Joaquin:Local Health District. <br /> (Signed)-------- ,c" fl.G ✓.... W- a <br /> -------------------------------------------------------(Owner and/or Contractor.) <br /> By:.. ' :. 0 -- - ----------------------------{Title)..--- ,�- .-- _- -- -------------- <br /> (Plot plan, showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION 'ACCEPTED BY----------;-V-e.- ----------•---------------- DATE------fn ------- <br /> REVIEWED �� <br /> -- -------- --- ---- - ------ <br /> BY--- •---------- •---- ----- DATE <br /> BUILDING PERMIT ISSUED___: =------------- ------_---•-••-----------'`-�:---------�------ DATE.. <br /> Alterations and/o recommendations:- -------.•---- <br /> . _ <br /> -------------------------- --••--------------------............... <br /> i �. <br /> .....-----•------------------------•--•---------------"------------------------------------------•-•-•-----------..--------------------------------------------I-..--_-------- <br /> i <br /> FINAL INSPECTION BY:.. --------- Date------ -2 ;1 <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street i 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stocklonr California 1 Lodi,California Manteca,California Tracy,California <br /> E$ 9 REVISED S-99 pM a-6I ATLAS <br />