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: '0 ti <br /> ------- ----- <br /> ..... . Y— ----------------- ------- - P ---- -APPLICATION FOR SANITATION PERMIT Permit No. ?�_,. _- � <br /> y� ��----------- ------- ----- d--`r--- <br /> (Complete in Duplicate) A <br /> --------- --- ------ --------- -------------- This Permit Ex fires 1 Year From Date IssuedDate Issued 4 r <br /> Application is hereby made to the:5an Joaquin Local HealA- ict fora permit to construct and install the work herein described. <br /> This application is made,in compliance with County Ordinance 549. <br /> JOB ADDRESS AND LOCATION__.O"� L-0 -----------y <br /> . c <br /> ---- "--*�-_•---�----�G� ate, <br /> !" ---- <br /> Owner's Name____ ` 4} 9 <br /> (. I..L' �' ._ - <br /> �''�` .-' ------------- -------------- <br /> Phone-------------------------------- <br /> 1--r <br /> ----- ------•-------- � <br /> Address-'--•-------------------•-------- --a -- ------�r ��-_ �-&- <br /> Contractor's <br /> _ ----------•--- <br /> - --------------------- <br /> --------•------- {------ <br /> Contractor s Name_..-----�-- --___-- - -�•�-�� .----------.. <br /> ----------------------------------------- <br /> ---=--- ------------------------------ Phone_. :. <br /> Installation will serve: Residence Apartment House ❑ Commercial <br /> F1 ., Trailer Court ❑ Motel,❑ Other [] <br /> Number, of living units: j Number of bedrooms _- �Numbei-;of baths `[ ' <br /> -- �_ Lot size ._. _- --_4----- <br /> Water Supply: Publics stem � ---------------• <br /> Y ❑ Community system ❑ Private t tcTable 7 ft. <br /> Character-of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3--Hardpan ❑ I <br /> Previous Application Made: (If yes,date--------------------J No Ea-­aew Construction: YesNo <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:: ❑ ' {'°`/�A: Yes El No [�]_____•- <br /> (No septic tank or cesspool permitted if public sewer is available within_„200 feet..) <br /> Septic Tank: Distance from nearest well________________ <br /> _ Distance from-------------------- ---------------- foundation___ Material- <br /> No. o{,compartments ----sized______________ _-_._.____________- <br /> -------------------------- <br /> --------------Liqu <br /> _______-.--.___..._--__-.------------- qudepth---- - -- --------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well----------.------Distance from foundation--------------------Distance to nearest lot line_______________., i <br /> �S A! umber of lines--------- Length of-each line Width of trench <br /> / lype of filter -------------- ---------- <br /> ------- ---••- <br /> -----Depth of filter material-----------------------Total length-------•---------:--•--------------------- <br /> Seepage istance to,nearest well__1..G�_Lz_f-----Distant Distance-)from foundation_ -� -- s'/ <br /> Dist nce to nearest lot line_ <br /> umber-of its -) . i ----- <br /> p P P / - --I_+nig�ma#erial, _------ Size: Diamet1 ! <br /> 'Depth-L-1 L -. <br /> spool e4 Distance from nearest well--------------.--Distance from foundation__):--------------. Lining material__________ __ _ <br /> ------- ---- ---- - I <br /> ❑ Size: Diameter-------------------------------------- -,,,a" <br /> Depth --------------- LiquidACapacity-----------,----------------gals. <br /> Privy: Distarce from nearest well_______________ Distance from nearest building <br /> Distance to.,nearest lot line__.__-._________________ <br /> --- ----------- <br /> Remodeling and/or repai ing (describe):_____._-. � ! <br /> 296Kv. - _ r r <br /> --------------------- - -� .l't9-` ------------------------ <br /> �- - — --- -------------------------- a - -- <br /> -------------------------------- <br /> -------------------------------------------------------------------- -------------:------------------- I <br /> _________________________________________________________________________________________________________S._______-.____________.________________-_--___._____-______.___ <br /> I hereby certif tha+ l have prepared this application and that the work will be done in accordance with San Joaquin Gounty, <br /> ordinances, State`I s, and rule d regulations of the San Joaquin Local-Heal+h'Dis+ricf-4 1 <br /> (Signed) <br /> [J ; <br /> ._- »x,�w _If_ <br /> BY: ---- - ----•--------•- ` Owner and/or Contractor) <br /> or) <br /> (r+le)-- --- r -_ <br /> (Plot plan, showing size of I , Iota+ion of system in relation-to welli, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..__ - <br /> REVIEWED BY ---------------------------------------- DATE---- � G-` <br /> -- ------ -------- --- DATE--------------------------------------iT k �'"`= <br /> - ; <br /> BUILDING PERMIT ISSUED------------------------ _. <br /> 6 � <br /> DATE ---- . <br /> Alterations and/or recommendations: � <br /> ,��- <br /> i <br /> ----------------------- -------------------- - --------- ---------------------- ------- --------------------- <br /> FINAL <br /> - - - <br /> ---------------------- <br /> FINAL INSPECTION BY:.............. �------ -- ------=`�`'�- Date ----- ---L� -- �- - �-� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselfon Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,Californiai <br /> Tracy,California l <br /> ti , <br />