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-- -- --------- ....... --- ..... - <br /> !� KATION FOR SANITATION PERF' Permi+ No. . ... -... <br /> .. ........ ....... - (Complete-in Duplicate) J �J <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 N 549. <br /> JOB ADDRESS AND LOCATION------v--�_ '.---- ..--- - --..-.------- ( .4lrC.�.� } j--`?�p7w <br /> Owner's Nam ----- f .. - -- - 0---- _ .-- _, Phone...:5--Y.Q:_-_ .{.- <br /> - ------------ ----- <br /> Address /A Q�' -- +a-r��C�-�! 1 -""" ................... <br /> - `... ....................... <br /> --- - <br /> A, � - <br /> Contractor's Name---------------6�✓----- -- - -- - --------------------------- ...---------------------............... Phone--......----- .............. <br /> Installation will serve: Residence Rj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _. l_- Number of bedrooms .-;I—Number of baths_.I---- Lot size ----A-CRE_AP-P.�------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 16' _ ft <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑—Sandy Loam E] Clay Loam &Y Clay ❑ Adobe C] Hardpan-- <br /> Previous Application Made: (If ._ <br /> f yes,date.........._ ..._ ) No Ey'SEl Construction: Yes No HA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: \(� <br /> ool <br /> in 200 feet.) <br /> 0 tank <br /> Distance permitted ifpublic sewer available nSeptic TankDito oneaswe - uDistanerom fouda ion- Mafei I .eP-4/j2..&L.7.k.�- f tacp - s- -----------Size.---. id depth ----- _--- \ <br /> _-'-" <br /> Disposal Field: Distance from nearest well_/j.9..___.-Distance from foundation.../.IL.....-.....Distance to nearest lot line_20__-... <br /> Iff Number of lines-------------------------------Length of each line-_ -6.6-A*_0-------Width of trench-_ ---------- <br /> Type <br /> g yp a Depth of filter material_-,-7---------------- length---1.-�.e,�}----------------- <br /> Seepage <br /> _._--__________________• <br /> Seepa a Pit: Distance tonearest well-1.01-.---__Distance from foundation_I.i-0.._.__ Distance to nearest lot line-72�_-.._. <br /> T e of filter matenal_��-��----_-. <br /> Number of its-.- Linin material_ B GIC__.. Size: Diameter-fl(_- -----------Depth_l.gc___-----------_- <br /> Cesspool: Distance from nearest well -------- .-----Distance from foundation...-------------- - Lining material..---------------------------------- <br /> n Size: Diameter- -- ----------- --------------Depth.-------------------- -- ---- - -----Liquid Capacity. --------------- -------gals. <br /> Privy: Distance from nearest well-.______-_.-_------_---_.._.--......Distance from nearest building._.-____.__.-_ ........__.._ . <br /> ❑f Distance to nearest lot line----------------------------------.__-----_--------®------/J-----------•---------------•---------------------........ <br /> _..-- <br /> Remodeling and/or repairing (describe):_-__...-. I....��_.�!_�_.. . 2Z_..-1�i.1/,t�L.L.._.. ----------_V <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-A----- -J <br /> -- -'v'.d.----.�_Ij:&Z-4,�_ ---------------- --------------------------------`----------------...__---- -Owner and/or Contractor) <br /> By:. ..--•-------- --------------------- ------------------------------------•--------- ..-.....--------(Title) -- --- --- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- - s R-P--------------_--- ...----------------- ------- DATE----- - 7-n-6�--` - <br /> REVIEWEDBY.---------------_---------------------_ ..------------------ -------------------------- DATE--------------------- .--- --- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------_ DATE--------------------------- <br /> Alterations and/or recommendations: -.............. ..-------------------- .........-----........ -----....----'-------------------------------------- --.. <br /> - - _ - . .. _. ... ... . ... .-- ---- -----------------­ ... <br /> FINAL INSPECit Date -- _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasolton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lodi California Manteca,California Tracy, California <br /> E.H.9 2M 1-6I Vanguard Press <br />