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•F. <br /> I APPLICATION FOR SANITATION P IT Permit No. . _. <br /> __ ,l <br /> ------ <br /> (Complete in Duplicate) r <br />" This Permit Expires 1 Year From Date Issu • <br /> D e issued ..-'� <br /> application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dost o <br /> `his application is made in compliance_ with�� 7 r an N 5 9 <br /> OB ADDRESS AND LOCATIONa- _L�: � .. - �- -----•---------•-.-- <br /> /� <br /> )wner's Name---•-- � �cf= _< ._. ��• � • <br /> address G7i .�.... - .... ,r% "` Phone -------------"----•----•-"--- <br /> ,r • ...... <br /> :on#ractor's Name--- r' - - � �.. - f� ,, --•---- -- -- --------------•---•-----------•----------•----•"--.....-------......----•---..---•• <br /> ❑ Apartment House ❑ /C Phone_.-.. <br /> tstafla+ion will serve: Residence ---" <br /> Commercial (] Trailer .Cf Jk Motel ❑ Other ❑ <br /> Number of living units: ..._-. Number of bedrooms I---- Number of baths __/..". Lot size ----- <br /> Ater Supply; Publics stem t <br />� PA Y� <br /> Y ❑ Community system ❑ Private Fk] Depth to Water Table ;-477 ft. <br />-haracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [j� Clay Loam El Clay [] Adobe E] Hardpan ❑ <br /> oYious Application Made: (If yes,date------ "_. _.._-".") No ® New Construction: Yes RI No ❑ FHA/VA: Yes ❑ No ❑ <br />(PE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available Lwithin 200 feet.) <br />. r <br />:ptic Tank: Distance from nearest well--jp--------Distance from foundation../O - .""-"-,Material-C,:' L_'�- ` <br /> No. of compartments---- ----- --.-_. <br /> Size.". . .t...-,t`` Liquid dep#h...------y---------- Capacity_,__) ,- -- <br /> fsposal l told: Distance from nearest well-.. 710.._.---Distance from foundafion_Z�. -_----. r' <br /> �' Distance #o nearest lot line _ <br /> Number of lines---•--..1..... -------- ."-.Leng#h of each line.../" � ..----.Width of trench.:. -y- N <br /> Type of filter materia,err -- Depth of filter material-.-/- " <br /> .--Depth i� <br /> eti-,JT".. - 9"----------- i <br /> Total length l <br />:epage Pit: Distance to nearest well-".�.....-. -�---"""" <br /> _---._--.Distance from foundation--------------------Distance to nearest lot line..._. 00 <br /> ❑ Number of pits.--..._..-;------r Lining maferial..........-- <br /> b. Size: Diameter ----- ---.Depth------------- ---------- <br /> aspool: Distance from nearest well-----------------Distance from foundation- �i <br /> is Lining material Size; Diameter -------- <br /> -----------------Depfh -------- -------- ------Liquid Capacity-...------ --------------gals. <br />'vY Distance from nearest well'.--"-------------------- Distance from nearest buildin <br /> ❑ Distance to nearest lot line --- -"--- g ------- ---- <br /> ------------------ <br /> modeling and/or repairing (describe)------------ <br /> ----------- <br /> -----------------•---- •� <br /> i <br /> --------------- <br /> ------•---•----------- --------------------------------------------------------------------------------------------------------------------- <br />------------------------ - <br /> -"•----------"-------------------••----•---•--------...-------------""---------"-----------------------•-••-•---•--- --- ------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> linances, State laws, and rule and regulations of the San Joaquin Local Health District. <br /> ---------- ----- <br /> (Owner and/or Contractor) <br /> By: -------- ----------- <br /> (Tie) <br /> t plan, showing size of lot, location of systemin relation to wells, buildings, etc., canplaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br />'LiCATfON ACCEPTED BY_- ,- 1 <br /> -.r�;eue�xrrt-- <br /> IEWED BY ---- -------- <br /> •----------------------------- -------- -•--------•--------• -----------------.. DATE-"--s---+�-7.-�.y------ --------------------- <br /> ------------- <br /> ----- - <br /> ---- <br /> --- ---- ---------- -------- ---.......................... ----------------------•---=- DATE---•-------------- ---------- <br />-DING PERMIT ISSUED------��--"---••---•--•----•--- - ---• <br /> ____ <br /> = - DATE ------- <br />!rations and/or recommendations:...._...."...,_-"-�--" �- ••"--•"��• " <br /> ---- •--- ---- - <br /> ----------------------- <br /> .--------•---•------•- •-- -.-- <br /> �- <br /> JAL INSPECTION BY:... <br /> --------------- <br /> ---------- <br /> C, %f, <br /> Date....." ?..... ...' .. ..............."... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street <br /> 124 Sycamore Street <br /> Stockton,California Lodi,California 205 West 91h Street <br /> Manteca,California ' <br /> 9 REVineo B-59 3M 3-j63 F.P.Cq• TratY,California <br /> l <br />