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FOR OFFICE USE; <br /> - �1-- V--- <br /> ---------------- <br /> ----- -- -------------f---- <br /> r Permit No. - ...__... <br /> 3 / � -----�_r. APPLICATION FOR SANITATION PERMIT <br /> _-- --.--�...........-_. (Complete in Duplicate} <br /> -'---- -'-------------'---- - Date issued ------• <br /> __________________ This Permit Expires 1 Year From 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 compliance with County Ordinance No. S49. <br /> JOB ADDRESS A LOCATI N.._-•--- �'� k -- ------- - '� I_��.►'!4(.__...: __ k,+�tn�° "� <br /> ue +�? eta ---------------- Phone <br /> Owner's Name--. - -- --a�..---- - -�-•- --•'------•--•-• �- -- <br /> Address �. ---------------------------•-----------....--------........................ <br /> ••-------•---•---••••---•--- <br /> ------------ 2 \ { �D <br /> Contractor's Name- 1C�ra` - -.. "`� Phone <br /> Installation will serve: Residence Apartment House 0;�L Commercial [ITrailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ______:�Number of bed ' __`Number of baths .__�-__ Lot size _.__. l�.......................................•--- <br /> Water Supply: Public system ElCommurii#y system ❑ Private' Deptli'to 11Jater Tabu. <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 �ew Construction: Yes ❑ No FHA/VA: Yes E] No � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> o r "( � �'� <br /> Septic T k: Distance from nearest wellZ ___.___Distance <br /> from foundation__�______________.Mat�tal..___+"'.G"- .____......... <br /> �• <br /> � No. of compartments--------- --- - .�.-r.__X�d�--�------Liquid dep+h------.�11i----'----Ca act t��--------- <br /> _Z0 <br /> _.__.... <br /> --- ----Size----• - p ty..... <br /> i <br /> Disposal <br /> Ffield: Distance from nearest welj----A_a-!_._Distonce from foundation.- 4__�....___Distance to nearest lot 1ine................. <br /> 1� `/ 5 4 <br /> Number of lines--__--_----- •-------------------Length of each line._______`�jQ-.------------Width of trench.---4�-•�--� --•------•------- <br /> I Type of filter material__._Y'QL. --------Depth of filter material.--)A--------------Total length---- e 11 <br /> --•-----•_•...... --------------... <br /> 4 Seepa Pit: Distance to nearest well--- °rO__-_ __-Distance from foundation.....?.!-.._.___.Distance to nearest lot line.-S�___..... <br /> Number,of p1ts____.:1---_--------_Lining material...Y'44.1------Size: Diameter_t; 3-------------Depth—-PJ; �-------...--------- , <br /> s <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material.............._-_.__._.._.__......_._ <br /> ❑ Size: Diameter DePth--------------------------------•----------------__Liquid Capacity--------------------------- <br /> els. <br /> Privy: <br /> Distance from nearest well--------------------•----------•--- - -:-- Distance from gist'building----_•------•- <br /> -------------------------------------------------- <br /> ❑ Distance to nearest lot line--------------------------------------------------------------------- . ............. <br /> Remodeling and/or re airing esc6be):-- ---___-• '-'--- --- .... <br /> .. •• . <br /> Z <br /> ... <br /> t <br /> -----..._._ --------- ------------------------ ------------..---------•--------------­-----­-------- _---------- - <br /> ---•-- --- - -- ---------------------•-----••-- ----•--------------•---- --•-----••------------------------•------- --•-----------------------------------••---------•------------------------ <br /> hereby certify that I have prepared this application and that the work will bee�one in accordance with San Joaquin County <br /> ordinances, State laws and rule d `egulations of the San Joaquin Local Health District. <br /> J Q� 7 ----(Owner and/ r Contractor) <br /> (Signed} /� -•- <br /> nfle <br /> By:------------------- _4F------------------------------------------------------ <br /> ------------------ - ----- - -----------------( <br /> (Plot plan, showing si of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY( - <br /> ------------ <br /> Y - `-- ------• ---------------------- DATE-------�-`-Zr.-r-L-2 ----------- <br /> REVIEWED BY---------------=---- --------- DATE._-• -------------=- ----------------- ------- <br /> ------------'-- ----'-- <br /> BUILDING PERMIT ISSUED---------•----------------•----- .. ---------------- DATE- ---------- ----=-------- <br /> Alterations and/or recommenda+ions:__ ..��- ---_--- ' ---Le_ "` �'� r�'Z--�"� -------- <br /> -1Z^- .. <br /> FINALINSPECTION BY:.... ................----------------- Date -' (P�------------- -------•-----------•-------------•-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT h i <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street ' r. 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-S9 2M 6-61 ArLAD <br />