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FOR OFFICE USE: <br />--------------n--- --- -------------------- ------------- No. <br /> APPLICATION FOR SANITATION PERMIT Permit . ....... <br /> ------------------------------------------------ <br /> ------ ---- ----- -- ----------- (Complete in Duplicate) Date Issued --- <br />-------------------- ----I------------- ---------- This Permit Expires 1 Year From-Date Issued'" <br />----------------------- <br /> Application is hereby madeto the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliancit7 with County Ordinance No. 549. <br /> r <br /> JOBADDRESS AND 'LOCATION-------I--------- ---------------------------------------------------------------------------------------------------- <br /> Owner s <br /> ----------------- <br /> Owner's Name-----------------Mr-.---Dnm_t I ng0__S=che_7--------------------------------------------•-------- Phone-NOM----------------------- <br /> Above-i OV --------------------------- --------_-_------------------------------------------------------------------------*----- •----------------------.------ <br /> --- <br /> Address----------------------------------------------- <br /> Contractor's Name---------pfl .54pt.IA...rRAnat -or"r iia e ------------------_------------------------ <br /> Installation will serve: Residence 0� Apartment House El Commercial E] Trailer Court El Motel 0 Other <br /> ❑ <br /> -:!-- Lot size -------- ------------•------- ------ <br /> Number of living units: Number of bedrooms 3___ Number o'f baths <br /> Water Supply: Public system 329 Community system El Private 171 Depth to Wafer Table -45-1-ft.- <br /> a4 1 ravel [] Sandy Loam D Clay Loam E) Clayo AdobeKj Hardpano <br /> Character of soil to a depth of 3 feet; Sand E] G <br /> Previous Application Made: (if yes,d.afe--------------------) No New Construction: Yes [3t No 0 FHA/VA: Yes E] No F-4. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1 <br /> (No septic tankorcesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------t <br /> Exldffllng No":-.of compartments---------------------------Size---_--------------------------Liquid depth--------------------------Capacity----------------------- <br /> Disposal.Field: J)istarfrom nearest well------------------Distance <br /> from foundation--------------------Distance to nearest lot line_____._.___.__._. <br /> -- �ce irest <br /> Number ----------------------------------- <br /> of lines...--------------I------------------Length of each line----------------------------:-.Width of trench <br /> 'e of filter material----.----t -------------Total length------------_----------------I----------- <br /> -------------Depth of filter material---------------------- <br /> t <br /> Type 'IN - .1 ).1 ...._.Dlistance to nearest lot line --------- <br /> e <br /> §p ii__Nonla�-------:Distance from foundation.l( <br /> age Distance to nearest we - 'i <br /> Exin&lng Number -----------Lining material-------rQO�X----Size: Diam'efer---3-3-1------------Depfh-25 ..-- e:------"-- <br /> -Cesspool: Distance from nearest well-----------------Distance from foundation-------------------LLining material_.-.____.__ ---------------------- <br /> "I Depth----------------------------------------------------Liquid Capacity-------------:__11----------gais. <br /> 0 Size Diameter---- --------------------------------- <br /> Privy: Distance from nearest well------------------------ r----- ---------------Distance from nearest building-------------------------------------------- <br /> Distance to nearest lot line---------------------------------------------------------------------- ---------------------------------------------------------------------- <br /> El <br /> in t��Utxi I I-ar -be ---tw)--- --------- <br /> Remodeling and/or repairing (clescri be)_----------------------- d ----- <br /> I ------- <br /> ------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------I---------------------- <br /> ----------------------------------------------- -----------I-----------------I- --------------------------------------------------------------- <br /> -------------------------------------------------------------I ----------- -------------------------------------I----------------------------------------------------------%---------- --- <br /> -------------------- --------- -- -------- ------ -- <br /> ---------I.-hereby- --__certify that- I­have,-prepared- --­-t-his.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 /> ice, Ince' <br /> Delta Septi.01!Tank SerV ------------(Owner and/or Contractor) <br /> (Signed)----------- - - ------------------- -------------------------------------- ------------------------ ------------------------------------- <br /> By:-------------------------.......Zerr7 .114n---------------------------------------------------------•---(ritle)-----Gene - ------------- - ------- <br /> ' __VAr_t can be placed on reverse side). <br /> (Plot plan. showing size of lot. location of system in relation to wells, buildings, etc.. <br /> FOR <br /> DEPARTMENT USE ONLY <br /> E------- ---------APPLICATION ACCEPTED . ...... - --- - - ------- ------------------------------- ------------------ DAT <br /> -------------------------------------- <br /> E Y <br /> ........................ -------- --------------- <br /> REVIEWED BY-------- ----------- ------------------------------------------------------------------- DATE--------------------- <br /> DATE------------------------------------------------------------- <br /> ------------------------- <br /> BUILDINGPERMIT ISSUED-------------1------q---------------- ---------------------------------------------------------------- <br /> Alteraflons and/or repornmenclations:----------:-------------------- ----------------------------­------ -------------------- <br /> -------•---------------- <br /> po 1� - ------------ ---------------- <br /> 7:i FW --------- ------------------------------------------- ------------------------- --------------- <br /> -------------------------------- ----------------------- ------------------------------------------------------------ <br /> ----------------------------------------------------------- ------------------------------------- ------------------------------------------------- ------------------------------------ -----------------­ <br /> ---------------------------------------- -------------------------------------------------- --------------------- ------------- <br /> --------------- ----- ------ ---------------- -------------------------------- ------------- <br /> - -------------- ---INSPECTION BY:.._.­_j_ Date--.-___-. .......... -------------­---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E6-9 REVIBEC e-59 F.F.Co.2H 6.60 <br />