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vR vrri-[ VJt: <br /> 7 _2�- ------ d 7 <br /> 1 _.-_ ___--___-_ APPLICATION FOR SANITATION PERMIT Permit No, 9/ <br /> --------- ----------------------------------------- -- (Complete in Duplicate) <br /> ---"---'----- ---- ------ ---------- --------- This Permit Expires 1 Year From Date Issued Date Issue ._1-- � <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 .LOCATION.- AMA......b A VIS.......... <br /> - <br /> i <br /> Owner's Name_ ,� l _ �s .�OO � ��_S_7F'�-1 C.T. <br /> ------ Phone------------------------------------ <br /> --------------------­---------------•-•---•-- ---- L, <br /> ------ ------- <br /> ------------------------------------ <br /> Contractor's Name_______ `` <br /> Q <br /> , <br /> ------------- PhoneV_� <br /> - ---------------------Installation --- <br /> will serve: Reside e ❑ Apartment House Commercial ❑ Trailer Court ❑ Mote! <br /> ❑ Other SCfi�9®1_ <br /> Number of living units: _- "____ Number of bedrooms -------- Number of baths -------- Lot size <br /> f �r� -------------- <br /> Water Supply: Public system ❑ Community system ❑ Private J[ Depth to Water Table —7 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 04 Hardpan [❑ <br /> Previous Application Made: (If yes,date____________________) Nov New Construction: Yes ❑ No jJ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: .. N <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 /> ___-._____-____ ___-_-_ " <br /> ❑&t.S*"C- -----•----------------- <br /> No. of compartments--- Size ----•------------ -------Liquid depth--------------------- (� <br /> Disposal Field: Distance from nearest well------ ----------Distance from foundation--------------------Distance to nearest lot line---------- <br /> 0 5S0,5tlt"C' Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------•--------____ <br /> Type of filter material_________ T_-Depth Depth of filter material----------------------- <br /> � otal length---------------------------------------- <br /> Seepage Pit: Distance to nearest well1 --------Distance om f undation_- Distance ce to nearest lot lin�_v1�Q___"__ <br /> Number of pits".-./1____--___-_Lining material____-- - <br /> Size: Diameter__}_$--- -_------Depth__.- ..-- ---------- <br /> Cesspool: Distance from nearest well-------------- __Distance from foundation__.------------------------ .Lining material-- --------- --------- ---------� <br /> ❑ Size: Diameter---- --------------- ----------------Depth----------------------- -- -- -------Liquid Capacity"---------- "-----"------- <br /> gals-.'g <br /> Privy:. Distance from nearest well______________--_ -------------__Distance from nearest building----------------------------------------- <br /> Distance to nearest lot line___________________________ <br /> -------------------------------------- <br /> ----- <br /> - - ------------------------------- --------- <br /> Remodeling and/or repairing (describe)_____________ ___ <br /> -------------------------- ------------- ------- <br /> --------------------------- <br /> - <br /> -------------- ------------------ --------- -------------- <br /> ----------------------------------------------------------------------------------------------- ----------------------------------------------------- -------------------------- --------------"-_.-- --------- <br /> I hereby certify that I hrepared this ap lication and that <br /> ordinances, State laws, an rthe work will be done in accordance with San Joaquin County <br /> ule and regulatio of the San Joa to Local Health District. <br /> (Signed)----------------------------_-- ___ ______(Owner and/or.Contractor) <br /> By:------------------------------ <br /> ----------- ------- <br /> '!• <br /> f <br /> -""--- _(Title]__. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pla Zon reverse side). <br /> ------------ <br /> AV <br /> j OR DEPARTMENT USE ONLY •� <br /> APPLICATION ACCEPTED BY____-_ <br /> ------------- ---------------------------------------- DATE------ --�f�•/�G------------------------ . <br /> REVIEWED BY ---- -------- <br /> ----------- -------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED_ <br /> `� -------------------- <br /> D TE <br /> Alterations and/or recommendations: -�/G G----- — T �� ----- <br /> F <br /> 1 _ ,4 <br /> B --------------------------- <br /> ----------------------------------------------- <br /> ---------------- --------------------- -- - <br /> -- - - ------------------------- <br /> - ­--------------------- <br /> FINAL INSPECTION BY:..--- - -"---- O----- --------------- - ---------- Date-- ------------------ S~�6 <br /> --- - <br /> -------- ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave- 300 West Oak Street 124 Sycarnore Street <br /> 205 Wes}9th Street <br /> Stockton,Calffornia Lodi,California Manteca,California <br /> Tracy,California <br />