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FOR FFICE U5 <br /> APPLICATION FOR SANITATION PERMIT Permit No. �jLG -• <br /> '� -----?11,121-bfes: <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 o. 549. <br /> JOB ADDRESS AP597cCATI N.-2-90 7.. <br /> , . <br /> - ••• <br /> ... ..:. <br /> . .� <br /> OwnersName__ ._.. _. ----- --- -- -- •---- - ----------------------------------------------------------- Phon .--.......--•-------...... <br /> i �_------Address---------------------- .... •--------•-- Phone Name.. om <br /> _ . � R <br /> t <br /> E Insf�llation will serve: Residenceo Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other ❑ <br /> Number of living units: _ .. Number of bedrooms _- Number of baths _1___ Lot size .CO. _�.- .-.•`. ` .............. <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .lft. <br /> t <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [3 Sandy Loam [I Clay Loam E] [] <br /> Clay /Adobe Herdpan ❑ <br /> ramu,/ <br /> Previous Application Made: (if yes,date_______.__--- ----I No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:"' r . ^'..� ,... <br /> (No septic tank or cesspool permitfed cif public sewer is available within 200 feet.) <br /> Septic Tank: Distance-from nearest`wellltiffl A_Distance rom fo ndation__./1....../.________-.Material--_- . .... .......... <br /> No-of compartments-_2--- ___Size- _� �_:__-Liquid depth_ ---1_.' <br /> -------Capacity-JbO­ •tom <br /> %Disposal Field: Distance.from nearest well____(rt2t,.Distance from foundation.. V_......._.Distance to nearest lot line-----_-. ... <br />+ {� Number of lines:_.._#_____ __ ________ _ _____Len th of each line____5p Width of #reach..Q _�i��!.___________._... <br /> T\ �f 9 --- <br /> Type of filter material. _ .�a-lG_____Depth of filter materiaf____._ ��__.__Total length---- �--------.:....... <br /> i <br /> Seepage Pit: r Distance to nearest welLJ( _______Distance from foundation----/-a.""'---.Distance,to nearest lot line----___. . <br /> Number of pits-----I---------------Lining aterial__R.Q -------Size: Diameter--- _,3�1_.---.-.Depth---_�.�?._---_-__----- <br /> Cesspool: Distance from nearest well--------------'._Distance from foundation--------------------Lining material____.______.-__.____._............___ <br /> [] Size: Diameter-------------------`-------•----- I-.Depth:=---------•-------------_-- ,_a_Liquid Capacity---- -----. ------------ -gals. <br /> {----------------------------------- . Y <br /> I. Privy: Distance from nearest wellfence from nearest building--------------------------.------:_._____. <br /> I <br /> } Distance to nearest lot line____________________ <br /> -------------- <br /> t - _------y -�__ �____-___E5 -' '------R-'--"-'---•------•--------•----------•-----------•----•---------_______ <br /> ' Remodeling and/or repairing (describe)----- -•------- -------------- <br /> --•----------•-•---------------•------------........ <br /> 4 <br /> € _ / <br /> i <br /> --•=------------------------ ----------------------•-----•••------...--•-------------•------------.._..----------------•-------------------•----------------------•------._....----- <br /> I hereby certify that I have prepared this application and that fIe work will be done in accordance with San Joaquin County <br /> ordinanceifat la and rules and regulatio s of the S Joaqui ocal Health District. <br /> St ned ,f L �� Contractorl <br /> • ( �g <br /> 1 _.�------.Title----•-- -------------------------------------- --------- <br /> (Plc+ plan, showing size of lot, location of system in relation to s, 'dings, elf., tan be placed on reverse side). <br /> L <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY, F.----"-J - �- DATE_''T�<T�------ --- /y G - -- <br /> REVIEWEDBY------_------------------•----------------------------- ---------; DATE <br /> BUILDINGPERMIT ISSUED-------• -----•--------------------- ---------------�•-----------------------------------•-- DATE----------------•-•-----...--•-•----------------------------- <br /> 1 Alterati ns and/or recommendafio s• # <br /> ------ ---------- <br /> L....�_.. - _-�--- `- ---------- ------ <br /> ----------'-"� - <br /> . . . o -------------- ........................ -------------------------------- <br /> �`�-:------ - ^----.•._.--- -----I---- <br /> --------------------------------- <br /> FINAL INSPECTION BY:---- Date....----------------------------:- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISEII 9.99 2M 6.61 ATLAS <br />