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APPLICATION FOR SANITATION PERMIT Permit No. <br /> k�umo�f � <br /> `--''-~ --r'--' Duhy |ouo6 <br /> Application is hone6v mu6o to the Son Joaquin Local Health D|v+rict for o permit to construct and lns+*U the work herein described. <br /> This application |smade |n compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND --- - -----------64-S00-------' <br /> [)*ne,'u Name--------- ------------ ---------------------------------------------- ----- ------------.- Phone-----------.------.- <br /> A6dress-''_---__-------'-----------------'-----------------'-----'--'---'------' <br /> ConhnctorsName-'' --------- ------------------------------------------------------ ------------------------------------------------ Phone_''--'''-'-''-' <br /> Installation ,ill serve: Residence � ���� H�� � Cummom�| � l��|er C�� � �c�| � ��r � <br /> Number of living units: _/~Number ufbedrooms Number of baths 8 Ln+ dzo '�����~�'..x����~_.-_--- <br /> Water Supply: Public system Community system 0 Private Pd Depth to Water Table .AA ft. <br /> Character of *oil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam [] Clay Loam Clay El Adobe El Hardpan [] <br /> Previous ''�� wn Made: Yes E] No 21 New Construction: Yes Ur No [� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Nn septic tank o, cesspool permitted if public sewer isavailable within 200 feet.) <br /> Septic Tank: Distance from nearest well---$-n------Distance from foundation---//P..........MoreriuLdT. <br /> �� No. ofxonnpmr+men+����������----..5iz,�.9����'��.��.-�_-Liquid 6�pfh-.��-----..C°poci+y-.'���� �--.. <br /> Disposal Field: Distance from nearest weU'S70^-----Distance from foundation 1�' Distance to nearest lot line 47 <br /> Numbnr o[ lines-----A% Length of each line-------4- of trench <br /> ' Tvpe of filter maferial / <br /> -'Depth of filter material--- 'Tot | length-- .......------------------- <br /> Seepage- Distance to nooroo wel|�'�''-�-D|stanov from foundation---------- -------Dis| nceto nearest lot |imz-''-'- <br /> [1 Number of pits----------------------Lining material -- --------Sbo: Diameter-----------------------Oppf6------ -- --- --- <br /> Distance from nearest °eJ--..............Distance from foundation--------------------Lining mn+nrioi'--''-���''���'' <br /> r_1 Size: Diameter---------- ----- ---------- ........Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------ ------------------------------------------Distance from nearest 60cling--- -------------------------------------- ' <br /> � <br /> Distancetonearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> . <br /> Remodeling and/or repairing (desc�6ek--_-.."---_-._------------'----------------------------------------------------------------- -------------------------------- <br /> --------------------- '__------'_-----_-------__------'-------------__---------'--_�---'--------_-----___------'-z---------____���� --------------------------------------------- .... <br /> �����------------------------------------------------'---_-------------------''---------'----------------------''---------------------1_1 ---------------------------------------------,------'' <br /> -----_-._----_-_-_.--_---_-__-..--_._._--.-'_-.__..-''-_--_'-'''--�----_'.-.---''-'--. <br /> | hereby certify that I have prepared this application J that the work will be done in accordance with San Joaquin County <br /> *n1inoncno. State |a*,, and rules and regulations of the San Joaquin Local Health District. <br /> / ^ A . <br /> (Signed)------ �--��--.-I-^�]8�R����---------.----------.---.------------- ---------------(Owner and/or Contractor) <br /> By:....-------------------------------------------------------------------------------------------------------------------------------(Tife ------------------------------------------------ ----- <br /> (Mo+ plan, showing size of lot, |nmutinn of system in relation to wells, 6uY|6lngo, o+c` can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> REV|EWED 8Y------------------------------------- --------------------------------------- --------- -------------------------------------- DATE-----.-----.----------. <br /> RU|LD|NG PERMIT ISSUED-------------------------------------------------------------------------------------------------- DATE--_-_..__--.-----__-' <br /> AK*r*tionsmnJ/orre:vmmen6a+ions-.----.- __-.__---._-.__.-.___-_____- <br /> -_---.----.� -���� `~=-�- _--_-._--'-''''_----------.__..___-- <br /> -----'''-�-''' ~~'�^'--'''��� --'''''@I�r''--_________.____�____________ <br /> - ^ . .. __~"_ ' ------__--.�,�_-._----'_-'_._-_-.-.--.--' <br /> .-__----_---- ����=". ---------- <br /> --------_���------_-----___-------_-----___-----_____-----_�����_�----__-------___-------_____-----__���-_-------___-------__---__---____---_-------------_ <br /> FlNALINSPECTION BY:-------------------------------------------------- -- --'-. Date.............. ---- ------- --'-----''-'��'-__ <br /> SANJOAQU|NLOCALHEALTHDISTRK3 <br /> 130 South American Street 300 West Oak Street /32 Sycamore Street m* North 'C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M /0'52 an,i^e6 W-z/oo <br />