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FOR OFFICE USE: <br /> ----- ---------- - ------ <br /> ----- ------- -------- --------------------------- <br /> 'APPLICATION FOR SANITATION PERMIT Permit No. .ZYZ� .�. <br /> ------------ -- ----------------'---------------- --- (Complete in Duplicate) <br /> ..:.. ... . . ...........�. This Permit Ex fres 1 Year From Date Issued 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. 549. <br /> /1! <br /> JOB ADDRESS AND LO ATIO ----- - '� 4�® 14 -- a Z? ....OF--- ������ Rv>-w <br /> Owner's Name------------ T!O-L X----�--}--n' _ll� ----------- -- --------------------- ---------------------- Phone--------- <br /> Address -------------------- 1.PL7--al[_---------------•I--•--------------------------------------------------•--------- <br /> . . Phone----------------------------------- <br /> ----- <br /> NamerL�artmenf <br /> ---------- <br /> Installation will serve: Residence.. House ❑ Commercial ❑ Trailer Cou# ❑ Motel ❑ Other ❑ <br /> Number of living units: ----t Number of bedrooms.___ Number of baths ___i___ Lot size _____ = _ �r -_________________ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tab1ef4* <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 H --New Construction: _Yes ❑ No &1-1—�A/VA: Yes ❑ No� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: = f -- �•�• _,.•- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance-from-nearest,well_--`------- <br /> Disfancefromwfoundation______________.___ Material-__-__________.___.___ <br /> _...__-____-.__.__-_---_-. <br /> No. of compartments - - - Size---------------------`------ ---Liquid depth_______________'_'__-_----Capacity----­---------- <br /> Dis osal -.- <br /> Field: Distance from nearest,welly, -_--'Distance from faitndation___________________Distance to nearest lot line_______.______... - <br /> E,V$7146- Number of lines------:-------------- ._.i s•�{Length of each line----------- <br /> ------- Width of french--------------------_------- _-- <br /> Type of filter a e i l .............Depth of fitter material-----------------------Total length--------.--_------ --- <br /> ------- ----------- <br /> ) �C V Distance to nearest lot line__._ <br /> Dumber of its----._ Linin material__�[j�daze: __ ____________ <br /> � ; <br /> Seepage Pit: Distance to P eare���eIL_-.t# ____..._g____Distance from fo Size: Diameter_z x_�____Depth.....,✓Y______________________ <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------------..Lining material__-__--..___-_-.-.----------------- <br /> . i <br /> Size: Diameter._._-T_.._I---------------- <br /> ❑ I f � --'----..Depth_ '-�--- - ---------'------'-'-------------Liquid Capacity----------------------------gals. i 4 <br /> Privy: Distance from nearest well__r.__.,, ) Distarce from nearest building ---------- 1r <br /> ❑ Distance to nearest lot line----------------------=---------------------------------------------- ----- ------------ - ---------- <br /> Remodeling and/or repairing (describ!): ----------------------------------------------------------------------------------------------------•------------------------------•----------• ------- <br /> i <br /> F , i <br /> .. 1 �. �, - <br /> t <br /> "l -.------q a •.. f'- <br /> hereby certify thanI have prepared this application and that the work will 6e done in accordance with'San.: County <br /> ordinances, State laws, nd rul and regulations of the San Joaquin Local Health District. ' l <br /> (P_f i I ��' x -- _____.____ ___-------------- _ ____Owner and or.Contractor <br /> (Signed) -- ( ) R <br /> ....�. ,.�sy - -- �.� - ------- ------ - -- (T )L _ <br /> ... -----• -._ itle — _�-- <br /> (Plot plan, showing size of lot, location`.of system An relation to wells, buildings, etc can be' placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 6Y'--- -------------------------------------------------------------- DATE------I S I'-7Z5--------------------------- <br /> REVIEWEDBY-------------------------------------------------------------------------------------------- ------------------------------ DATE--------------------------------= <br /> BUILDINGPERMIT ISSUED------------------------- ------------- ------------------------------------------------ ------------- DATE-------------------------------------------- --------------- <br /> -and/or recommendations: --- ---- 7'77777-7!-•--=-- - - ---------------------------------------- <br /> V, <br /> -----------yam: : ----------•---- ---------------- ----------- -- ----- .-.------------------- ------------ ------------------------:�;;;.:--- - -- g ----- :-- _ --- . --------------- <br /> ------------------•--- -------------------------•--- - ------------._.. -----------------•----------------------- -------------------------------------------•----• -----------------------------------'---------- <br /> FINAL INSP N BY:.. 0---------- <br /> Date ' ' -~'r� <br /> SAN JOAQUINt 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 /> F.P.co. <br /> E ' <br />