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k <br /> Permit Na. ...!(.�s3�-- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date,Issued <br /> 4 made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ApplEca ion is hereby <br /> This application is made in compliance with County Ordinance No. 549. <br /> --- � <br /> �( <br /> JOB ADDRESS AND LOCATION---------- t.� ! - = <br /> •'�� b;_ �I--------------Phone <br /> •---- <br /> !- ----- ----- - <br /> Owner's Name------------------ ---. _ •-- - -•--�- <br /> Address--- ----------- ---- -------;--- i Ph, ---- <br /> e-A-11?oneii <br /> r6 -- � <br /> Contractors Name______________ _______"��.---- � Motel ❑ Other <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court �❑ ❑ <br /> Number of living units: _/.-__ N er of bedrooms "_ Number of baths j----- Lot size --------------_------------------------i=1------------------ <br /> Water Supply: Public system Community system E] Private ❑ Depth to Water Table _� . <br /> Character of soil to a depth of 3 feet: Sand ❑�Gravel E] Sandy Loam ❑.Clay Loam ElClay [3 Adobe ardpan [3Previous Application Made: Yes F-1No ��New Construction: Yes No El x <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________ _____Distance from foundation-------------------Material_______._____-"----_ <br /> r No. of compartments--- <br /> Size----•--•------------------------Liquid depth__--- ----------------Capacity;---------------------- <br /> - �� � from nearest well----- ----------Distance from foundation----------------- <br /> .,!Distance to nearest lot line <br /> ----------------- <br /> Disposal Field: Distance �I <br /> �� ._Number of lines Length of each line iIWidth of trench---------------------------------- <br /> Typa of filter material--------------------- -.D pth of filter material----.- ----:Total length------------------,�-------- <br /> i <br /> ��j i---- <br /> ,,/� _.� Distance to nearest lot line_ �---- <br /> Seepage Pit: Distance to nearest wellf F!�__ ...._-.- <br /> stance fro four ation---•--------••---�����--�-�-- Depth --�h�`-^--��-• <br /> Number of pits-"�- -*---Lining materialF_- --- =--cize: Diaet^er_--', ,�i k <br /> Cesspool: Distance from.nearest.welY I—______________�_Distanee-from found"afian...._....._-.__.__. Lining material__..___-._.._,h----- als. <br /> �_.�., Depth ----- I Liquid Capacity-----------j;----------------9 <br /> ❑ . �,M -'�-Size".Diameter ------- --- <br /> Privy: Distance from nearest well--._._._.-"-------------------------------- Distance from nearest building...________--____ir_------.-------------- <br /> Distance to nearest'lot line------ ---------t------� ------ -------------------------------------------------------------- ----L'------- <br /> _ <br /> - -- <br /> - <br /> El <br /> - -. <br /> - - -------------------•--- <br /> Remodeling and/or repairing (describe):----"----- ---- / iM --•--------- - ---------------------- <br /> -- i% <br /> _ZZ <br /> �� _ - l <br /> -------------- - ------------------------ <br /> ------------ <br /> -----------------------------------Z-----------------------� - ­ 1-1 <br /> I hereby certify that I have prepared this app_cation and that the work-will be done in,accordancewith San J7- .................oe-------------------------------------�!!l----------------------------------------oaquin County <br /> ordinances, State la s, a d rules and reg lations of the San J aquin Local Health District. it <br /> •! ------ <br /> and/or ontractor) <br /> -_ ---- ----------- -------- <br /> [Signe ) ---- j l` t ------- --- f <br /> I --------- <br /> - - - -(Titles) � 1. <br /> -- - ---------- ---- <br /> Y� --• <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si e).i <br /> FOR DEPARTMENT USE ONLY <br /> ----•---------- DATE_�-T-------------------------'1------------------------- <br /> APPLICATION ACCEPTI=D BY__ .._._ —" " <br /> --- ---------- DATE---- -------------------=.... ........--------I------- <br /> REVIEWED BY------ ------------------------ - - ----- -- ---- <br /> --------------- ------- ------------ ------------ <br /> BUILDING PERMIT 155UED_----------------------------------- ------------ - ----•-------------- ----- - ------"DATE-::- ;ZIX.----------- ------------•- <br /> I� � <br /> ---- -------- --------- <br /> Alterations and/or recommendations:- �(:. ------------------------------- <br /> --------- ------- <br /> IM ------------------J -------------------_ <br /> '�----.-•------6------- <br /> ----�---- ------------ -�------------------- - �--• - - -------•- --;--�--��--- - SIM---------•-�----•-----------...-�--------• ----------�-••-------- <br /> --------- ------ <br /> ---------•------------------------------------- <br /> S7 ------------------------------ <br /> FINAL INSPECTION BY:. �----- ---------- ----------•---- Date. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> l32 5 camore Street $14 North 'IC" Street <br /> 130 South American Street 300 West Oak Street Y <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br /> i <br /> ES-9-2M 145446 AT W OO❑ 12-s4 <br />