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FOR OFFICE USE: <br /> _ ..._....._.. -- -. -..... .. - <br /> APPLICATION iOk SANITATION PERMIT Permit <br /> ._..._... No. <br /> . .....__.-.'---.............-.-.._--.... .. .__ (Complete in Duplicate( <br /> ........ ....... ...............__.. - <br /> _.... _. This Permit Expires 1 Year From Date Issued 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 applicetio i's me e n mpli ithJCounty Ordinance Na. 549. <br /> JOB ADDRESS D LO ATIO .) ...........h-GeJ..... <br /> Owner's Name...........- ...._ZoY.e..d?_ ....._... Phone........................._........ <br /> - ------------------.._.....------------------------_----- <br /> Address.--------..... r"��---•-----/------- -- --- ---- - - ...__.._.. ..................................._..--------..................................................... <br /> Contractor's Name --Lc3.3-- ..t.y.. ........... �3.S.T ............................................. Phone................................... <br /> Installation will some: Residence Ef Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .-/---. Number of bedrooms .-3.. Number of baths /..._. Lot size ..... .......................... <br /> N�p <br /> Water Supply: Public system ❑ Community system ❑ Private a Depth to Water Table Y_ ft. - <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobeijo Hardpan ❑ <br /> Previous Application Made: (If yes,date...................-) Nog New Construction: Yes W No ❑ FHA/VA: Yes ❑ No ® ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: l v <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet,) / J <br /> Septic Tank: Distance from nearest well./..^'.!?!.'_Distance 1,,.�from foundation....C�_.......Material----- vd -r?.f.'.4(..--------.. <br /> No. of compartments........_a .Size._.Jny. ..............Liquid depth......450................Capacity....SOo <br /> Disposal Field: Distance from nearest well... ",..Distance from foundatign^..y{..d. ....Distance to nearest lot line.......2 0' <br /> ,® Number of lines............... r'f' _ length of eac�n I�ne.JO..�T�.. ........Width of trench........�!t+.!._'.._....... <br /> Type of filter material._./4.,.-1..5�_A:.....Depth of filter material......IAP2......Total length.......Z...1—... .. ... <br /> Seepage Pit: Distance to nearest well..../..tL.o'_....Distapce fttQQm fo ndation....._:zR...Distance to nearest lot line..,'-I_10 - <br /> '�' Number of pits---------- materibl..-..AA_r..�..Size: Diameter_-_....3_8.._..Depth....:Z..�.................... <br /> Cesspool: Distance from nearest well.................Distapce frorrLfoundation....................Lining material...... <br /> ❑ Size: Diameter------------------------- ------..-Depth-------------------- ...............................Liquid Capacity_.........................gals. <br /> Privy: Distance from nearest well...................................:............Distance from nearest building..........................._........ <br /> ..... <br /> ❑ Distance to nearest lot line--........................-......---.._.......---................._....._....._._............................_... ........... <br /> Remodeling and/or repairing (describe): .........__......_ . ------ ........-.................................................... ... ......................... <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, an rules d reg tions of the San Joaquinyocal Health District. <br /> (Signed)---- :dJ .--= . .. . .. .. . . ....._ ....�_ .. .._.__.. (f� / -......._----.._(Owner end/or Contractor( <br /> ....- <br /> -- -------------- ..Ti+le)------------------------------------.... ..... .... .. .. <br /> By:----- <br /> (Plot plan, showing si-ze 6f to , ace#i system i ale#ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... ..Ce .�... ---- --- ----.................. 1­ DATE...I �1/.. ? ........................... <br /> REVIEWEDBY..............................................- - ........---._....._._......- -----------..-----__------------------ DATE............ ...................................... <br /> BUILDING PERMIT ISSUED--------------------- DATE.----------------------------------------------------- <br /> Alterations and/or regio men afions:........-. .4 ' / i� -`�---° -.---- <br /> ........ ...... ---- C•-•sem-c"r / <br /> ........ <br /> ..... .... ..... ..........A...._�...................:-. ........ ..-------------- J <br /> - «-1 -- -------- ----_-- <br /> FINAL INSPECTION BY:... .._ . - -f� "'Ta....... ...... ........................... - - - - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soalh Amerimn Strael 300 W..l Oak Strut 124 Sycamore 51ne1 205 Wnl 911, 511eel <br /> steckton,California Lod],California Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 2M 5.62 ATLAS <br />