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rrvrc urriLt ubt: - <br /> 3 ------- <br /> ------ _ 1�7�� <br /> �� ----.---- ------ Appf_ICA710N Fbft SANITATfON PERMIT Permit No. ................. . . <br /> -------------- --------------- ------ ------ (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date IssuedS— <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. 549. <br /> JOB ADDRESS AND LO TION________________-:7—.% ._ . G' Q� <br /> -�---------------- <br /> Owner's Name------------ / ms s ✓` g�eF,5-f - . I <br /> - -- -------------- 7 <br /> Address--------------2.- 7f _ <br /> Contractor's Name .y-9o_r--------•---------------- ----------------------•----------- ------ Phone.------•---••----------•----------- <br /> � ----------------------- <br /> Installation will serve: Residence �Npartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms -;�_ Number of baths �_ Lot size ..._. _�1C--/dQ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay [] Adobe Hardpan ❑ <br /> Previous Application Made: {If yes,date....................} �No New Construction: Yes <br /> ❑ No 5P--1=HA/VA: Yes ❑ No ❑ , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i I <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 /> ..._.___-_____.._____..___....__.___._. <br /> ❑fix/ No. of compartments------------ -------- ----Size--------------------------------Liquid depth----------------- --------Capacity---------- --- <br /> Disposal Field: Distance from nearest well-.---_.-Distance from foundation__--� �9 <br /> l�__.__._._Distance to nearest lot line._._____._..__ Q1 <br /> Number of lines--------------/--------- _-- --Length of each line-_----------- ------------Width of trench.---...Y "-------------- 4" <br /> Type of filter material. Depth of filter material----.--19'I._.....Total length _._ <br /> g ------------ <br /> p g <br /> Seepage Pit: Distance to nearest wel�,__.- Y_------Distance from foundation------------.-------Distance to nearest lot line._-__.________._ <br /> ❑ Number of its--------------:___.-__Linin material-----------------------Size: Diameter----------------------Depth------------------------------ V <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material------------------- <br /> ❑ Size.: Diameter..------'7------- ---------------Depth------------- --------------- Liquid Capacity ----------gals. <br /> Privy: Distance from nearest well____________________ _.__._-_______._____Distance from nearest buildin <br /> ------------------------------------------ <br /> El <br /> Distance to nearest lot fine__ .__...-.____.______. {� <br /> Remodeling and/or repairing (describe):..... ----------- ---- <br /> describe):..... ..............__._ <br /> ---•--------- ------------------ --------------------------------------- ----------------------- <br /> ------------------------ <br /> ------------------------ <br /> ------------- <br /> ---------------------------------------------------------------- <br /> --------------------------------------------------------------------------------- ---------------------------------•--------------------------------- <br /> I hereb erti y that I have prepared this;application and that the work will be done in accordance with San Joaquin County <br /> ordinances State aws, nd les and regulatians;.of the San Joaquin Local Health District. <br /> (Signed)------- ----- - -- -- ------ - ----- - - -------------------------------(Owner and/or Contractor) <br /> By.. ----------------------------- Title <br /> ------------ - <br /> otpan, showing size of lot, location of system in relation to wells, buildings,.etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--.--- <br /> ------------------- <br /> Y - ----------------- - - ------------- DATE---------�/ ._.l4 c�J' <br /> REVIEWEDBY------------------- ------------------------------------------------------------------------------------------ DATE <br /> ------------------------------- ----------- <br /> U1LDlNG PERMIT ISSUED. --------------------------------- ------- DATE--- <br /> --------------------------------------------- <br /> ------------------------- <br /> aerations and/or recommendations________________ <br /> -------- - -------------------- ------------------------------------------------------------------ ------------ <br /> - <br /> ----------------------------- <br /> - ---------I----------------------------------- <br /> ------------------ <br /> FINAL INSPECTION BY:---- Z---V ----- ------------------- - Date--------- -/- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />