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FOR OFFICE USE: <br /> APPLICATION POR SANITATION PERMIT Permit No. . <br /> ...................................• --................. (Complefe•in Duplicate) <br /> Date Issued <br /> ----------.-.- This Permit Expires S 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 No. 549. <br /> . ' <br /> JOB ADDRESS AND LOCATION .-. � L.! T _ ....._.., ..r......- QG�E'' 0/ <br /> Owner's Name.......----- �_.TL.LY------- <br /> Address <br /> -----Address............................................. <br /> ---- -•z-z.•���rY---------------E------------------------• ----------•---•-------------------------..... ....._..._..........._---....._..._..__._.... <br /> Contractor's Name.... .R R. 1-S/T--...... ..... .O/.v ............ .. --- ...._...... Phone <br /> ...... <br /> (O_�_ - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..!_:.. Number of bedrooms ...Z-Number of baths_f..... Lot size _J`p -_x. ._1_�` .�................. <br /> Water Supply: Public system 5�L Comihunity system E] Private E] Depth to Water Table 7,.7ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay ❑ Adobe K Hardpan ❑ <br /> Previous Application Made: llf yes,date__ ___ _ __________ ) No fX New Construction: Yes ❑ No Dd FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest w II_jVQjt45 �r from---Distant ffdati -/� dam .. & <br /> ounon- - --•--......Mater` # .. <br /> t <br /> No.iof compartments. . .............. S'rze4ilk-9.3b,.r1t eLiquid depth..,.r. __... ....__.Capacity-900.1&4Z <br /> Disposal Field: Distance from nearest well................ Distance from foundation....................Distance to nearest lot line........ <br /> [X,FjjS*jA1G Number of lines...................................Length of each line.. ............_..............Width of trench._._ 1n <br /> Type of filter,material.............'.........Depth of filter material......................_Total length.......................................... �✓ <br /> Seepage Pit: Distance to nearest well..........._-i Distance from foundation................... Distance to nearest lot line................. ^� <br /> N(fxL5/fNumber of pits..- ..?--.....��_.Lining material.........::........... Size: Diameter.......- Depth_._._..... ._- --....-..----.-... <br /> I , ; <br /> Cesspool: . . Distance from nearest well..........._...Disotance from founds+ion................ Lining material_.... <br /> Size: Diameter. De th..,'_.......'. - Liquid Capacity gals. <br /> Privy: Distance from nearest well... i....................Distance from nearest building__..........r......................_.... . <br /> ❑ Distance to,nearest lot line - -------------­-......................................................... _.... <br /> Remodeling and/or repairing (describe}��.- !.1: !,1���...... <br /> . ....................... �----------- LP ...... <br /> - - -------------- ---•-------------------••---•---•---------- ---------------•-------•--•---..._............---..._...............------------- .......-•--•....._................. .... <br /> . - <br /> - ----------------- ......... ---- ----- - --- ------ - ......- ---.------------------------------------•--------------------------- ----.... .......---------•--------..- <br /> I hereby certify that I h e pr pared this application and that the work w'lb be done in accordance with San Joaquin County <br /> ordinances, State laws, and mules d regulations of t an Jopquin Local e'a'lfh District. <br /> (Signed)--------.............................. .. ----- ��. o � I - o ----• ......--.._ .(Owner pdpr Contractor) <br /> By:.......... - ...... .....:.f�L/_�..... ... ....(Title)...... <br /> / <br /> (Plot plan, showing size of lot, location of system in 'relation to wells, buildings, etc., can be plat on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY....... . ... .. ' i . ......._. DATE. _;V_.: -' -...-•...---•- <br /> REVIEWEDBY ............... -------------------------------- -----------------•----.,.....-...............--------.__............__._.. DATE_—............................. <br /> BUILDINGPERMIT,, ISSUED........ ..................._................................_........................ -••••.... DATE----.............................••. <br /> Alterations and/or'recommends+ions:------...---------•.............. -- ........_....---......... _...._...... ------ <br /> ...................................................... .........._............................................... ........... i <br /> ........................ .......... ........-.........................---............................._......---------------------------•----- --------------------- •• --•---............._...._.................. <br /> ............................................................................................................................ ._......... -----------------................. .................. ............. <br /> .................................................................................................................. - - . ----•-......-.-.----. ......--........ --......._.._.................. ...._............----... i <br /> FINAL INSPECTION BY:------.. _---------_- Date........�77+--y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Massillon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi.California Manteca,California Tracy, California <br /> EX 9 2M 1-E7 Vanguard Press <br />