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<br />APPLICAtION I=OR `SANITATION PERMIT Permit No . ............ �,...�
<br />................:............. (Complete in Duplicate)
<br />.--. This Permit Expires I Year From Date Ilssued Date issued _....-.........._..
<br />ppiication is hereby made to the San Joaquin Loca', Health District for a permit to construct and install the work herein de�cr bed.
<br />This application is made in compliance with County 0dn nCe No. 5 9.
<br />je)c?C;,g r�rc-0✓r� ��
<br />JOB ADDRESS AND LO ATI N_I.i!,e
<br />Owner's Name
<br />Phone
<br />._ .............._... ......... ..,�........_ ............. ....-------
<br />_..._»....
<br />Address.......,. t »�..... M .....».....„... ............. ...... ............ _............. .....,......_._.......... ...........
<br />ContractorsName .--------.. .......... ....... ............» ......_ .._.,................. Phone... �.._ .. �......_..
<br />Installation will serve: Residence Ze"Apar#ment }-louse ❑ Commercial ❑ Trailer Court ❑ Motel i D Of-her10
<br />❑
<br />Number of living units:.Z.. Number of bedrooms . .. Number of baths .._. Lot size 1jW.X2_��.�.............-._.._._.
<br />Water Supply: Public system CC) Community system, Lam„ Private j,?_*Deptl to Water Table A�Of#.
<br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑
<br />Previous Application Made: (If yes, date .................) No New Construction : Yes PE' Nn ❑ FHA/VA: Yes 4~” No ❑
<br />TYPE OF INSTALLATION AND SPECIFICATIONS:
<br />(No septic tank or cesspool permitted if public sewer is available within 200 feet:)
<br />.. ,�E'y'._....-...
<br />Septic Tank: Distant© from nearer*. well- wl'�,�..... Distance ¢nom fcaynciat`<.Non_..rte.._------- Ma.er,ai.............. �'". ..
<br />Q�l✓" No. of compartments...,,�,� ._._.............Site 1%J ,e Liqui 3 depth,. ................Capncityo%.i f ......
<br />Disposal Field: Distance from nearest we':!._1aD.✓,. Distance from founda#ion._..Z.!�. .,...Distance to nearest lot line4?..........
<br />Number o= lines ...-.....� .... -... Length of each line..,t�1 Width of trench.-. !_ . .
<br />t�rri
<br />Tyrie of filter material./, a Dapth of filter material -00e l..... Total length--..�lr�, ... ......... .
<br />01
<br />Seepage Pit: Distance to nearest r�well . /.'�G�.f, ,...._Distance from �fo,u�, �daticr,..trc� trl__......Distance to nearest lot ine ...............
<br />W " Number of pi#s... .sire: Diame#+ r. Depth
<br />w�'+...._......._, Lining ma>t3rial.._�r. ._, - � ,...... �-�����•�•,....�
<br />Cesspool: Distance from nearest well.-... .......... .. Distance from foundation ...,»........... .... Lining material................,.,.,.....,....,.. ,
<br />❑ Size: Diameter. _.-.....____ ....... ...... -.- Depth .......... _ .... _.... .... _.....Liquid Capacity........-...._.: .........-gals.
<br />r'rivy: Distance from nearest wel.. .................... ....,._.....,............. Distance frorn nearest building ....._.._.............. .....„
<br />❑stlot i?^o._.
<br />Distance to nearest .,, --_.. ................... ..-....._.. ...... _..._._..._........,.......,._.»........
<br />Remodeling and/or rapa.r;ng
<br />_..,»,.�. ..._., .
<br />" 4
<br />....» _..........,..» ..."....,,, «..... ................_ ....__..._._._.....-...»...._ ..._. ,,.,,.......-<..............,..,.,...............<......,...--...,,..
<br />w ....................,....... ............ ............. ....... ...,..._..__u.._„_..,...................._..._.................... ..._...........__,..,...... .---__.._..,,__w,.._.,...... ........
<br />.
<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 r gula#ions of the San Joaquin Local Health District.:
<br />(Signed).. ✓.'ontractor)
<br />ay:.. _.. ................._ ...(Title)...d ✓� = �.,,... y..,,, �_.: "+� .
<br />(Plot plan, showing size of lot, location of system in r ren L't.-Wells, bungs, a#c., can be placed on reverse side).
<br />FOR DEPARTMENT USE ONLY
<br />APPLICATION ACCEPTED BY.______ ...... ............. .,.....�. _, .�.�.. DATE...... .....� "..� C-�.........»......
<br />REVIEWEDBY........ ... .................... _._............._ . ........... _._.. ...... DATE ----------- ..._ ............ ..,...-.....,.......
<br />BUILDING PERMIT ISSUED .................... ........... ..,......... DATE...... . ....................
<br />Alterationsand/or recommendatiomt:.._w.................................. ._ ., _.....»-............. ,.,................ ,........ _...... ,................. ..,..........................._.k
<br />..,
<br />........................ ..-.._»........ ......_.._.................... ......... .._....._................ -......-..... .....-........... , .........
<br />»,................_.... _......_....
<br />r.
<br />FINAL INSPECTION.......,.,............ Date......�,�� . ...�d x�?..............................._.......
<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />1601 E. Mazoiion Ave, 300 West Oak Street 124 Syromom street 205 Wast 9th Street
<br />Stockton, California Lotti, California Mcnteca, cal►for"fa Tracy, Colifornic
<br />r.ry,co.
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