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rUK Urrll.0 U3t: <br /> A%. ICATION FOR SANITATION PER.--A' Permit No. .-�0.. ...�:... <br /> - (Complete in Duplicate) <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 No. 549. <br /> JOB ADDRESS ANIO LOCAT N_1L74. 1.. ... - ^-"�1L'f/H G�1 - - - <br /> Owner's Name - -�-- -- a- ------ -/.-..-- -Tl./7. __.__.----.._-------------------..... Phone-$' rr--- ----- -3 � <br /> Address-'- .... - - -- - " -Ckt <br /> Contractor's Name----- -- -.�iidfl�S�� .--.. .._ tYc � 6.-- .-- -------------- -- Phone! 05d - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ($f Motel ❑ Other ❑ <br /> Number of living units: .. ----- Number of bedrooms . ... Number of baths ----- Lot size - --- ----....._. <br /> Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table�O ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-_....._.__._- I Nd,;K New Construction: Yes ❑ No)?�- FHA/VA: Yes ❑ No(;' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic,CTank: `Distance from nearest well_._. - Distance from foundation--.----------------Material ----------- --------- <br /> Elgi .LSA No. of compartments....-...... .,.----- ----Size.................-- ------.---Liquid depth . -.--_._-- . Capacity----------_----_-.--.- <br /> Disposal Field: Distance from nearest well -Distance from foundation.....-_-----------.Distance to nearest lot line-.-----.-..._... C <br /> ❑`LKl Slit—, Number of lines------------ - Length of each line_ -- ------------------------ of trench-------------------------_.--.._. <br /> Type of filter material__...............__-_Depth of filter material Total Total length....-..___---------.--------------D... \ <br /> i <br /> Seepage Pit: Distance to nearest well_P�-O.EL..___Distance om f ndation.3:S.-_.-5 Distance to nearest Ipy/t�line.._ .....' 6 <br /> Number of pitsCf)............Lining material..._ Size: Diameter.4.O_.-_..__.Depth__/.�0. _._--_.___..----- <br /> Cesspool: Distance from nearest well __...._------Distance from foundation._.._._ ...... ..Lining material.._._ - -- --- ----------_.._ <br /> ❑ Size: Diameter. - --------- ----- _..............Depth................_....-__.---_---_----_-._-Liquid Capacity------------ -------------gals. <br /> Privy: Distance from nearest well...______.___._._-.__._._.....-...Distance from nearest building.._.. ---------------------------------- <br /> El <br /> ..............._--_-----..._._❑ Distance to nearest lot line .--- -- ---- -- . - --------------- ------ ---- ----------------'---- ------------------------ <br /> Remodeling and/or repairing (describe):- ..... -1� Z�- `--� ....... ------ -------- - ------ <br /> ------ <br /> - <br /> --------._...._'-----'------------------------...-------.----------------------------------------------------------------------------6Z---- ----------------------------------------------- <br /> -------------------- <br /> ---- <br /> ---._.-- ------------------------------------------------ <br /> - --......... . - .------------------ -------------------- --... ---.. <br /> I hereby certifand <br /> e prepared this plica#ion and that the wor +Will be done in accordance with San Joaquin County <br /> ordinances, State , es andlegulat" s of theSa Joaquin L Health District. <br /> (Signed) ._ - Y._ --- . ... __.- .. . .yi... - .. . ...... ........ .al ..(Owner and/or Contractor) <br /> (Plot plan, s wing size of lot, location of system i relafion to wells, buildings, etc., can be pla d on reverse side). <br /> go zi FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDB .... - - - - ' - - DATE- - -� �y -------------------- <br /> REVIEWEDBY---------- ------ --" - - _... -- - ---- -------- - - -- - . DATE---- ------------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ---------------------------- ---- -------_--------- ---------------- ---- DATE- ------------------- ----- -- ---- <br /> Alterations <br /> -Alterations and/or recommendations:- ................ . .. ..- - - -- ---------------------------------------------------------------- ------ ---- <br /> -------__----------------------- ..........----- ------ ----- -- -- --- ------ --- ------------------------- --- ---------- --------- - -------------------------------------- <br /> -- _. __. __. . -- - <br /> r <br /> FINAL INSPECTION BY . _. _ Date.... <br /> S� JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />