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vrt %.jrri%.c uJ[: <br />--•-...--- --- <br />•-•• ••••••"•-••-• ................ ....-------- APPLICATION FOR SANITATION PERMIT Permit No..ctL.j_ (o„� <br />--..---------._.w................. (Complete in Duplicate) <br />- r ••-• •••---. ....... 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 comp lance with County Ordinance No. 549. <br />0, IE_ 14 1464 1 4641 <br />JOB ADDRESS A LOCATION__".7ssr..,e4^'�''_i?u.X�.ssi>-•6�. 2d -0Z <br />_..._.._D._-/_.. . <br />Owner's Name .•. .._............. Phone .................................. <br />Address- •--•- LII.---•- �i <br />Contractor's Name ..... sir! <br />................. <br />..................................... Phone .......... <br />Installation will serve: Residence E]Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ <br />Number of living units:... Number of bedrooms _....Number of baths Ytot size .., <br />.----- •---------•---•- <br />Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ........ ft. <br />Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam 2r -,C -lay Loam ❑ Clay ❑ Adobe ❑ Hardpan � <br />Previous Application Made: (if yes,date--- _------ _--------- ) No[] New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ' <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic 4: Distance from nearest well ___.._'`.Distance from foundation___.,1R_'* ....... Material _....._._-.-•----_• ”-• <br />----- N <br />20 No. of compartments.....-__-_ . ......... Size..yf V~f f.'447� _._ Liquid depth__...}- ................. ._ Capacity../._A-•.- A.. <br />.�--- N <br />Dispos geld: Distance from nearest well....rx.'o..`.__...Dlstance from foundation..I..l,..'......,...Distance to nearest lot line.,...___.___. <br />Number of lines_.• -____._..3. O <br />--.---. Length of each line_..._!• -V-- --_----..Width of trench.....?...�_,._--.--•------------- <br />Type of filter material ------ S,.%t_-_..___._.Depth of filter material.-...._!_!".'.r___Total length ....... <br />m <br />Seepage Pit: Distance to nearest well_____________________Distance from foundation...._._.._._._.._._.Distance to nearest lot line-... ---------- _-_ <br />❑ Number of pits -__.-.______----_.__.Lining material __.___-__._...._-__..Size: Diameter --____ ................Depth..._._......._._...______.____._ <br />i <br />esspool:Distance from nearest well-__• ............. Distance from foundation -------------------- Lining material --- _-__............................... <br />❑ Size: Diameter ------- ..-._.----------------------- Depth .............. ..--•-. •...---••••• ------ ......... <br />.Liquid Capacity. ........................... gale„ 0 <br />'rivy: Distance from nearest well ._..-".--____.•________________...... _......... Distance from nearest buildingcc <br />❑ Disfance to nearest lot line ..................................... <br />Remodeling and/or repairing (describe):..,._-. -----.. <br />................................ _....... ----._....... "-.------................ ----•-------- ................ ....................................................... <br />• N <br />............... ­ ................... ------------•--------••-_-•------•-------•-------•--..._.........I---•------------- -............... -.-.------------- _............ -------- ----- <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />(Signed)• .................... .. ----• •--•-- ------------------------ <br />----- --------------"'(fir and/or Contractor) <br />Byi:----------•-__........ <br />''" Title <br />(Plot plan, showing sae of tot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ...... <br />REVIEWED BY. .............. <br />BUILDING PERMIT ISSUED ......................... <br />Alterations and/or recommendations:..__...._ <br />........................................•----.....••__-------..._.-- <br />P12- r rf----- _----_-"-----------• --._ DATE ... X7.- _.A <br />J. <br />------------------ - -------- -------------1- ••-----•----•-•••••---•-- DATE ...----•... .............. <br />--------------------- <br />--•-•........................._---...--------------------......-.---- DATE_ ---------------- _.. <br />.................. ................................. •-•.........----•••-•-. •....................--...........-._.....----••.................-- <br />..................................•-.............-•---------------------------------------------------- •---.-................................. ........_........•..- <br />................................... ........... ----•-------..---••...•--•..............--••-----........_......•-•--••------------••--................-•-••.........._ <br />........... ..../-........--•-•-•----...........•••. ••--... <br />FINAL INSPECTION BY:..t�/,�,!r�?'��i,•4!r�............ r l� <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. ffa:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Stockton, California Lodi, California Manteca, carifornia Tracy, California <br />